Customer Service

Consent Form

These forms are used to obtain an individual’s consent to allow a representative(s) of their choice to access the individual’s protected health information for 30 months.

If you are the individual consenting to make your information available to others, use this Arise Health Plan Consent Form:

Download Arise Health Plan Consent Form

If you are a participant of a self-funded plan and would like to grant others access to your health information, please complete the Arise Administrators Consent Form:

Download Arise Administrators Consent Form