Get Priority Health Change Form

The Priority Health Change Form is a crucial document that enables users to update their primary care provider efficiently. This guide will provide clear instructions on how to fill out this form online, ensuring a smooth process for changing your primary care provider.

Follow the steps to complete your Priority Health Change Form online.

1. Click ‘Get Form’ button to access the Priority Health Change Form.
2. In Section 1, provide your personal information. Fill in your first name, last name, middle initial, employer name, Social Security number, and group number found on your ID card. Ensure this information is accurate as it identifies you in the system.
3. Proceed to Section 2 to specify your new primary care provider (PCP). Enter the member or dependent's name and select the reason for the change from the options given. This can include moving, dissatisfaction with your current PCP, or personal preference. Additionally, provide the new PCP's name and address to complete this section.
4. Indicate whether you or your dependent is a current patient of the new PCP by selecting ‘Yes’ or ‘No’ for each individual listed.
5. In Section 3, authorize the change by signing and dating the form. This step confirms your request to change your primary care provider. If you are signing on behalf of a minor or as a legal guardian, please check the appropriate option before signing.
6. Once you have filled in all necessary information, review your form to ensure accuracy. You may then save, download, print, or share the completed form as needed.

Complete your Priority Health Change Form online today for a seamless transition in your healthcare provider.