Use this form to tell Priority Health who you want to have access to your personal and health information.
What you will need:
Your Priority Health contract number (on your membership card)
Name, address and phone number of the person or people you want to have access to your information
Estimated time to complete: Less than 5 minutes
Processing time: Within 3 business days after you submit the form
Use this form to remove permission for Priority Health to share your personal and health information with specific people.
What you will need:
Your Priority Health contract number (on your membership card)
Name, address and phone number of the person or people you want to have access to your information.
Estimated time to complete: Less than 5 minutes
Processing time: Within 3 business days after you submit the form.