CONFIDENTIALITY AUTHORIZATION FORM

Please download, fill out,and submit the CONFIDENTIALITY AUTHORIZATION FORM  to support@americashealthshare.org

The purpose of this form is designate America's HealthShare and Advanced Medical Pricing Solutions (“AMPS”), as your Designated Personal Representatives to act on your behalf in communicating with and handling billing and payment matters with your healthcare providers.

The completed form will be included in your membership record.