Health Champion helps navigate the maze of today’s health care with healthcare advice and healthcare advocate services

Health Champion Personal Advisors = The Link Between the Consumer, the Patient, and the Complex Health Care System

Thank you for visiting the Health Champion website. We look forward to working with you.

In order for Health Champion to speak to your health care providers and/or your insurance company on your behalf, we will need to have the appropriate forms completed and signed.

Health Champion will even coordinate your care and schedule routine appointments, removing one more burden from your day so you can spend more time with your loved ones.

Health Champion HIPPA and Personal Representative Form(s)

For your convenience we have included the most frequently used Health Champion forms. Please download the two forms below.

Sign and date the forms where noted. Completed forms can be mailed or faxed to our secure fax (860) 284-9757.

Health Plan Forms

Many health plans have their own Release of Private Information form that will also need to be completed, signed and dated by you. We have provided links to several of the health plans forms for your convenience. If your health plan is not listed here, call the office for assistance.

If you do not find your health plan on this list, please contact your health plan to obtain their HIPAA form.

836 Farmington Avenue, Suite 223, West Hartford, CT 06119. Toll Free: (866) 674-9913, (860) 674-9913.
Mailing address: Health Champion, P.O. Box 384, Farmington, CT 06034-0384.

Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for consultation with your health care provider. If you have any concerns about your health, please contact your health care provider.