PDF Forms (all PDF Downloads)
Packets
Member Registration Packet (for adults and dependents ages 13 and up – one per person)
Dependent Registration Sheet (simple sheet for any dependents age 12 and younger – up to 5 per sheet)
Individual Forms for Reference Only! The above packet assumes agreement with all forms below.
Billing Information & Authorization
Authorization to Email Protected Health Information
Acknowledgement of Privacy Practices
Medicare Statement of Understanding (only for those eligible for Medicare, typically those 65 and older)
Online Information
If you can’t find what you’re looking for, you can call our office at 509-823-4650.
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