Member Form Links

Are you looking for quick links to member forms?

Some member forms are available online for electronic submission. You can find them here:

https://www.impacthealthsharing.com//forms

Or, here are links to other Member Forms. 

Application Add-On Family Members

https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/Impact_Form_ApplicationforAdd-onFamily.pdf

Application for Leaving Family

https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/Impact_Form_ApplicationforLeavingFamily.pdf

Authorization Release Health Information

https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/Impact_Form_Authorization-ReleaseofHealthInfo.pdf

BMI Verification

https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/Impact_Form_BMIVerification.pdf

Commitment Permissions 18YO

https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/Impact_Form_Commitment-Permissions-18YO.pdf

Denial of Service Intake Form

https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/Impact_Form_DenialOfService_IntakeForm.pdf

Expense Out of Country Reimbursement

https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/Impact_Form_Expense_OutOfCountry.pdf

Medical Expense Form

https://app.impacthealthsharing.com/forms/medical-expense

Permissions

https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/Impact_Form_Permissions.pdf

Transition to Senior Membership

https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/Impact_Form_Transition-to-Senior.pdf

Pre Notification

https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/Impact_PreNotification%200720.pdf

Maternity Guide https://f.hubspotusercontent40.net/hubfs/5943296/Member%20Forms/ImpactHS_MaternityGuide_0120.pdf