Forms

If your claim has been denied and you require us to file an appeal on your behalf, please select your plan below and complete the corresponding form.

Appeal Authorization Forms

 

Once completed, please mail the form to the address below, or fax to: 941.209.5652.

Western Ohio Sedation Associates
PO Box 865666
Orlando, FL 32886-5666

Once completed, please mail the form to the address below, or fax to: 941.209.5652.

Western Ohio Sedation Associates
Western Ohio Sedation Associates
PO Box 865666
Orlando, FL 32886-5666

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