Fillable Patient Forms
You can submit your registration forms directly to Spectra Health using these secure links!
Form links on this page will direct you to a secure form developed using Jotform. Jotform is a HIPAA compliant service that allows your registration forms to be completed virtually by you and transmitted directly to Spectra Health’s Medical Records Department. If you would like more information on Jotform’s security practices, you can visit: https://www.jotform.com/security/
- HIPAA Authorization Form
- Financial Authorization
- SpectraPlan Eligibility (2025)
- SpectraPlan Application (2025)
- Dental Health History Form
- Dental Consent for Another
- Dental Release of Information (ROI)
- Medical Release of Information (ROI)
- Behavioral Health Release of Information (ROI)
- Upload Income Verification
- Designation of Consent for Another to Authorize Treatment