Download HIPAA Release Form (20 KB)
Under the HIPAA Privacy Rule, an individual must authorize release of his or her protected health information before we can get started. In order for SCA to research your case and confirm eligibility, please return this completed form to Spine Care Alliance (SCA) as soon as possible. Once SCA receives your form, an SCA representative will contact you via phone or email. If you have any questions, please contact the SCA hotline:
1 (877) 389-8848
Spine Care Alliance
3840 Via de la Valle, Suite 100
Del Mar, CA 92014
Fax: (858) 225-1886
NOTE: Upon receipt of your FAX, an SCA representative will contact you via phone or email. We request that you also mail the original signed form to us at the address above.