Mayo Clinic Authorizations and Service Terms

The Mayo Clinic Authorizations and Service Terms form authorizes Mayo Clinic to release information to:

• Your insurance company so they can promptly handle all claims.
• The person you designate as your billing addressee.
• Accrediting and quality organizations.
• Your other healthcare providers.

Please download, print, review, and sign and date the Mayo Clinic Authorizations and Service Terms form below. Once the form is signed and dated, it should be faxed to the Mayo location where you are receiving medical services.

Arizona — Scottsdale / Phoenix

Download the Mayo Clinic Authorization and Service Terms form.

Fax to: 480-301-8009
Questions: 480-301-8434

Florida — Jacksonville

Download the Mayo Clinic Authorization and Service Terms form.

Fax to: 904-956-0010
Questions: 904-953-7058

Minnesota — Rochester

Download the Mayo Clinic Authorization and Service Terms form.

Fax to: 507-266-4530
Questions: 507-284-2421