Member Forms

​Member Reimbursement Forms

Hill Physicians encourages our members to be vaccinated against common ailments and infectious diseases such as influenza. Check with your doctor on scheduling your flu shot and any other preventive screenings or immunizations for you and your family members.

Flu Shot Reimbursement Form
​Hill Physicians recommends getting your flu shot at your doctor’s office. However, if you prefer to get your flu shot at a retail location, Hill Physicians will reimburse the cost, up to $60 per Hill member.
​Zostavax Vaccination Reimbursement
Hill Physicians members 60 and over who receive a shingles vaccination from physicians outside of our network may request reimbursement using this form.
Non-Medicare Member Tdap-Adacel Reimbursement Form
For Members who do NOT have Medicare Part D. You may request reimbursement for the whooping cough vaccine.

Authorization for Release of Medical Records
​To request access to your patient health information, you first need to fill out a release form.​


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