In a continuing effort to improve our service to you the following forms are now available for download and completion.

 

Once your form is completed you have a choice to fax to our administrative office or drop off at the front desk.

Please read each form thoroughly for specific details for advanced notice required, billing cycles and fees that may apply.

As always if you are not clear on how to complete the form, then call or stop by the front desk with your form for assistance.

INFORMATION REQUEST FORM

Use this form to obtain billing and payment information
Obtain documentation to submit to healthcare provider

MEMBERSHIP CANCELLATION FORM

All automatically billed (EFT) memberships require a 45 day advanced notice to cancel.
Early Termination Fee of $150 may apply.

MEMBERSHIP HOLD - MEDICAL

All medical holds are done for a minimum of 30 days and a maximum of three months.

MEMBERSHIP CHANGE REQUEST FORM