Cohere Health

<a href="https://payerinfo.zendesk.com/hc/en-us/article_attachments/10818400256791/Duplex-US-CT-of-Head_-_Fax_Form.pdf" rel="nofollow noopener noreferrer" target="_blank">Duplex-US-CT-of-Head - Part II Fax Form</a>

- <a href="https://payerinfo.zendesk.com/hc/en-us/article_attachments/10818400256791/Duplex-US-CT-of-Head_-_Fax_Form.pdf" rel="nofollow noopener noreferrer" target="_blank">Duplex-US-CT-of-Head - Part II Fax Form</a>

<b>As these forms will be updated intermittently, please re-download them each time you fill out a fax form.</b>

Fax Form: Duplex US, CT of Head

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