Get Bioiq Restriction Request Form

This guide provides clear and detailed instructions on how to complete the BioIQ Restriction Request Form online. By following these steps, you will be able to effectively submit your request for restrictions on how your protected health information is handled.

Follow the steps to fill out the BioIQ Restriction Request Form correctly.

1. Select the 'Get Form' button to access the BioIQ Restriction Request Form and open it in your preferred online editor.
2. Begin by filling out the required fields. Enter your first name, last name, and gender as prompted. Ensure that all personal information is accurate.
3. Provide your BEMSID, which is necessary for identifying your account within the BioIQ system.
4. Include your phone number to facilitate any necessary communication regarding your request.
5. Read through the consent statement carefully. By signing below, you confirm that you do not want your personally identifiable biometric results shared with WebMD, Truven, or other service providers.
6. Sign and date the form at the designated areas to validate your request. Ensure your signature is clear and legible.
7. Once the form is fully completed and signed, you may save your changes, download a copy for your records, and print the document for mailing.
8. Mail your completed Restriction Request Form to BioIQ at the following address: Attn: BioIQ Security Officer, 1222 State St. Suite 200, Santa Barbara, CA 93101.

Complete your BioIQ Restriction Request Form online today to ensure your health information is managed according to your preferences.