To ensure that your insurance is billed correctly and quickly, please complete the following forms and return them to Bill My Health Insurance via mail, fax, or email. Visit each of the three forms separately or complete all forms by clicking the Full Forms Packet link below. Each Adobe Acrobat PDF file can be completed on your computer through the fillable PDF system. After you complete the forms, either by printing them out and completing them by hand, or by filling them in on your own computer (please be sure to save the files to your personal computer for your records), please return them to us as soon as possible.
Forms can be:
- Mailed to Bill My Health Insurance at 12730 Spectrim Lane Ste H Midlothian,VA 23112
- Emailed to info@billmyhealthinsurance.com by saving the completed PDF file onto your computer and attaching those files to an email through your personal email client (Please remember to save the PDF file to your computer and attach it to your email).
- Faxed to (804)595-0619
A free download of Adobe Acrobat can be found at this link.
» Enrollment Form
» Notice of Privacy Practices
» Authorization for Services
» Full Forms Packet
