Consent Form

Complete Your Consent Form to Begin Accessing YourBlueprint®

After your healthcare provider initiates your enrollment, please provide your consent.

There are two ways to finalize your enrollment listed below. You will need to submit a form that provides your consent and HIPAA authorization.

A series of slightly opaque blue dots arranged in half circle pattern
Icon of pen and paper, signifying an authorization form

Option 1: Online

Complete online with DocuSign®: e-consent & HIPAA authorization form

Please complete and sign the consent and authorization form online through DocuSign®.

Icon of postal letter, signifying the printing and mailing of a form

Option 2: Offline

Download form, complete, print & send via e-mail, fax or mail

If you prefer to provide your consent and authorization offline, please download and complete the form. Then send it to the email, fax or mailing address provided on the form.