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Authorization Form Instructions PATIENTS PLEASE INCLUDE A COPY OF YOUR GOVERNMENT ISSUED PHOTO ID AS WELL AS THE BEST CONTACT PHONE NUMBER WITH YOUR COMPLETED FORMPlease completely fill in ALL areas
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Acceptable forms of ID include government-issued IDs such as driver's licenses, passports, and state ID cards.
Anyone who needs to verify their identity for a particular purpose is required to file acceptable forms of ID.
To fill out acceptable forms of ID, provide all requested information accurately and legibly.
The purpose of acceptable forms of ID is to verify a person's identity and confirm their eligibility for certain benefits or services.
Accepted forms of ID must include personal information such as name, date of birth, and a clear photograph.
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