Forms
( Mouse over forms for descriptions )

What Form Should I Use?
Most forms available on the site require Adobe Reader. If you are unable to view forms please make sure you have the latest version of Adobe Reader installed.



Interactive Forms
Interactive forms allow you to enter information on the form using your computer instead of filling the form in by hand. Typing your information in the form decreases the chance of errors that could result in a reimbursement delay. You are still required to print and sign the forms.

Transmitting Request Forms
The preferred method of transmitting request forms is over the web. Igoe Administrative Services offers a secure convenient way to upload your form using our Flex Website. This method guarantees we received the form and provides a historical log of all forms submitted. You are also able to Fax or mail the form. Please fax or mail forms to the fax numbers or address provided on the form.

Submitting Request Forms
Click here for detailed instructions on how to complete the form and what documentation must be provided. You may fill out the form online, but please make sure to print and sign it when you are finished.
Common problems that could slow down your request are:
  • No signature on form
  • Not enough documentation
  • Submitting duplicate request
  • Change of address box not checked
  • Request form not completed

  • more...



    Health Insurance Portability and Accountability Act (HIPAA)
    Health Information Release Form Due to HIPAA Privacy regulations, Igoe Administrative Services is unable to respond to requests for information from non-participants (family members or others). If you wish to give permission for someone to be given information about YOUR account you are required to complete the Health Information Release Form. This form must be signed and submitted EACH time a non-participant contacts Igoe Administrative Services.