Third-party identification for all consent forms is required to process your request. Please be aware that HASA has 72 hours from the time your request is received to update the system. Your request can be submitted through any participating provider or by having it signed by a Notary Public and faxing it to 210-918-1376.
To download the HASA Opt-Out Request Form, click here. (By completing this form your information will not be available to physicians and other healthcare providers).
For a Spanish version of the form, click here.