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Important!

If you are an existing Passport Health client, please be sure to submit the same information you provided at the initial time of service to facilitate the location of your records.

Where do you work?

I hereby authorize and request Passport Health, and/or its affiliates and franchisees as applicable, to periodically transmit my personal health information to my employer or a third-party designated by my employer in the context of program administration, physically, via facsimile, or electronically as circumstances permit. This is an ongoing authorization and request and applies to any and all personal health information obtained by Passport Health and/or its affiliates and franchisees, at present and in the future. I understand and accept that there are security risks inherent in using electronic means to communicate protected health information, including, but not limited to, electronic capture of the message en route. I further understand and accept that Passport Health cannot guarantee the security of systems external to Passport Health through which messages may be transmitted.


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