Provider Forms

For assistance with finding or submitting completed forms, contact Provider Services at 650-616-2106 or

Forms for Non-English Speaking Patients

Authorization & Referral Forms

Please do not use the Prior Authorization Request Form for Pharmacy Drug Requests.

Claims & Billing Forms

Clinical/Health Assessment Forms

Staying Healthy Assessment Tools

Directory Information Change Form

Use this form to submit a change or verify that your information in HPSM's provider directory is correct.

Dispute Resolution Forms

Assignment & Un-assignment Forms

Quality Improvement Forms