Forms

If your claim has been denied and you require us to file an appeal on your behalf, please select your plan below and complete the corresponding form.

Appeal Authorization Forms

Once completed, please mail the form to the address below, or fax to: 941.209.5652.

FDHS Anesthesia, LLC
FDHS Anesthesia LLC
P.O. Box 735641
Dallas, TX 75373-5641

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