BackSome forms are specific to the type of plan you have. Others are generic. See below for our most requested forms. Or click on your plan type further down the page to see more options.
If you have questions about which form to use, call the toll-free number on the back of your Healthfirst Member ID card.
Commonly Used Forms:
Authorization to Release Protected Health Information (PHI)
Complete this form if you want to give someone (such as a family member, caregiver, or another company) access to your health or coverage information.
Appointment of Representative Form (AOR)
Complete this form if you want to name someone you trust to act on your behalf to ask for an exception or appeal, or to make a complaint with Healthfirst.
Health Care Proxy Form
Complete this form, and have it signed by two witnesses, if you want to appoint someone you trust to make healthcare decisions for you if you lose the ability to make decision for yourself.