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Participation Confirmation Form

           

  • Schedule your appointment
  • Download this form and bring it to your appointment 
  • Have your doctor sign the form
  • Fax the form to the HealthCare Strategies at 855-423-9430.

 

If you have questions regarding the Participation Confirmation form, or need to confirm the receipt of your form, please call HCS at 1-800-582-1535 x3401.