***This website will be offline for scheduled maintenance from Friday, June 30, 2017, at 9:00 PM ET until 2:00 PM ET on Saturday, July 1, 2017.***
Forms
 
Click the links below to view, download or print these forms:
Registration Materials:
1. Registration Form
2. Registration Form Instruction Booklet
3. Opt Out Revocation Request Form
4. Sworn Statement in Support of Challenge to Registration Determination (SWS-1)
Monetary Awards for Retired NFL Football Players and Representative Claimants:
1. Claim Form for Retired NFL Football Players and Representative Claimants
2. Instructions for Completing the NFL Concussion Settlement Claim Form
3. Monetary Award Claim Package HIPAA Authorization Form
4. MAF Diagnosing Physician Certification Form
5. Pre-Effective Date Diagnosing Physician Certification Form
6. MAF Claim Package Kit (all of 1-5 in one set)
7. Diagnosing Physician Sworn Statement: Inability to Provide a Diagnosing Physician Certification for a Deceased Retired NFL Football Player Without Medical Records (SWS-2)
8. Third-Party Sworn Statement: Functional Impairment (SWS-3)
9. Sworn Statement by Retired NFL Football Player: Reasons for No Objective Evidence of Eligible Season(s) (SWS-4)
Derivative Claimant Awards:
1. Derivative Claim Form
2. Instructions for Completing the Derivative Claim Form
3. Derivative Claimant HIPAA Authorization Form
Other Documents:
1 Authorization for Release of Claims Information
2. Request for Change in Representation Status
3. BAP HIPAA Form
1-855-887-3485 | ClaimsAdministrator@NFLConcussionSettlement.com | P.O. Box 25369 Richmond, VA 23260