Tivity health authorization form 2025

1. Click ‘Get Form’ to open the tivity health authorization form in the editor.
2. Begin by entering the patient’s name, provider/facility, and patient ID in the designated fields. Ensure accuracy for seamless processing.
3. Indicate whether you have a referral from a healthcare provider by selecting 'yes' or 'no'. This is crucial for authorization.
4. Fill in the requested start date for therapy. Use the date format MM/DD/YYYY for consistency.
5. Specify if this request is for a new episode or continuation of care by checking the appropriate box.
6. Detail the type of injury or condition related to this request by checking all applicable options provided.
7. Complete additional fields regarding treatment history, diagnosis codes, and patient assessments as required.
8. Review all entered information for accuracy before submitting your authorization request through our platform.

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