Prior Authorization Form

Providers can use this form to submit a quick prior-authorization request without logging into our provider portal.

Tip for Faster Submissions:
If you have access to our Provider Portal, we recommend using it for authorization requests. Your patient’s information is already pre-filled—just select the service, enter the appointment date, and click submit. Requests take less than a minute to complete.

No portal access? You can still submit using the form below—no login required.