Provider Specific Authorization for Release of Information Forms:

• Aetna
• Ameritas Dental
• Anthem - Blue Cross
• Blue Shield
• Cigna
• Delta Dental
• Direct Dental
• Fortis
• Guardian
• Health Net
• Kaiser
• MetLife
• PacifiCare
• Pacific Life
• Premier Access
• Principal
• SeeChange
• United HealthCare
• March Vision Care