FORMS

WoMBA is a patient/applicant driven system. All data entered is collected by you and or on behalf of you. WoMBA, utilizes leading cutting edge technology, some vendors or medical facilities may not understand how our self driven portal operates and may request traditional paperwork. If requested, please download and fill out the below forms. The forms can then be emailed to your WoMBA direct account or may be uploaded to your profile in your profile in your user portal.

DOWNLOAD FORMS BELOW


> WOMBA - HIPAA AUTHORIZATION FORM

> HIPAA Privacy Authorization Form


Please note: you can email documents, files and x-rays that you would like to store by emailing YourUsername@MyWoMBA.com.