Tips to ensure your file can be accurately received and processed:
If you wish to provide consent to a parent, guardian, or other individual, please print and complete the Permission to Discuss Medical Billing and Charges form from the
Billing for Medical Services page and upload below.
- Completion of the form in its entirety is required
- Only hand-written signatures will be accepted.
- Use a computer when completing and submitting files.
- Download the file onto a computer and then complete the document on the computer.
- Do not complete the file in a web browser.
- Do not use a mobile device.
- Compatible file formats are .pdf,.doc,.docx,.jpg,.jpeg,.tif,.png.
- There is a limit of 10 files per upload.
- The maximum size of a file is 4MB.