Request a new Business Associate (BA) Agreement

To request a new Business Associate Agreement ("BAA"), please complete the form below and press submit. Fields with an asterisk (*) are required.

The Professional Integrity Office will contact you if we need further information and let you know when this process has been completed. Typically, the turnaround time on getting a signed BAA in place (depending on language request changes) is 14 business days. Please let us know if this is a rush so we can determine if a quicker turnaround time is possible. If you have questions, please contact us at 813-974-2222 or email at

Thank You

* = Required Field

BA Primary Contact (used for legal notification) *
BA Secondary Contact (optional)

Requested By

Enter "N/A" if not applicable