Patient Forms
Patient and PRIA agreements, and a copy of the insurance card.
Complete them online, email to customercare@avation.com or fax to 614.559.6771.
Looking for Clinician Forms? You can find them here.
Patient agreement form (fill online or download pdf to fax)
PRIA agreement form (fill online or download pdf to fax)
Copy of insurance card (front and back)
Insurance prior authorization cannot be initiated until all patient forms have been received.
Need Help?