Cigna authorization for disclosure form 2026

1. Click ‘Get Form’ to open the Cigna Authorization for Disclosure Form in the editor.
2. Begin by filling out the 'Verification' section. Enter your name, date of birth, and phone number where you can be reached. If applicable, include your Social Security number and Member/Participant ID card number.
3. In the 'Requested Restrictions' section, clearly describe your request for restrictions on the use and disclosure of your private health information (PHI).
4. Indicate if you wish to deny access to family members covered under your policy by checking the appropriate box. Complete any necessary verification questions on page 2.
5. If desired, fill out the 'Your Preferences' section to restrict specific types of outreach from Cigna, such as phone calls or emails.
6. Finally, sign and date the form at the bottom. Ensure all required fields are completed before submitting.

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