Behavioral Privacy Forms

Cigna Behavioral Privacy Forms

If you want to allow someone else (such as a spouse, friend or attorney) to access your health care information, use this form:

If you want to receive Cigna correspondence at a confidential address, use this form:

If you want to limit who your health care information is released to or how it is used, use this form:

If you want to identify someone else who will make health care decisions for you, use this form:

If you want to obtain a copy of your health care information that Cigna maintains, use this form:

If you want to either request a change to or cancel any of the above requests, use this form:

If you want to learn whether Cigna has released any of your health care information to a third party, use this form:

If you want to disagree with Cigna's denial of your request to amend your health care information, use this form:

If you want to amend or correct health care information that Cigna created, use this form: