COMMERCIAL TRAVELERS

Obtain an Authorization

The HIPAA Authorization appears below in Adobe Acrobat PDF format to be downloaded.

It is a one-page form

For questions, please call between 8:30 am and 4:00 pm Eastern Time: 800/756-3702

(Authorization Form )

You must have Adobe Acrobat PDF viewer to view and print this form.

(Free Download)

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If you would like to contact us about your insurance needs, call us toll-free at 1-800/422-6200 from any location in the United States, send us an E-mail message, or fill out our Inquiry Form.