Forms

To better serve you, we have made our forms available to download for your convenience. Simply click on the desired form, print, complete and mail to the address below.

Information Change Form - Fill this out if you would like to change your Primary Care Physician, address or telephone number. A Customer Service Specialist may contact you with additional questions.

Authorization Forms - Fill this out if you would like to allow Physicians Health Choice to speak with someone other than yourself regarding your membership.

Appointment of Representative Form - Use this form if you would like to appoint someone else to speak on your behalf during the Appeals Process.

The documents on our website are presented in PDF format. Click Here to install Adobe Acrobat.