Forms Center

This section provides various types of forms to members. Simply click on the form below, print and mail directly to:

Physicians Health Choice
Attn: Customer Service Department
P.O. Box 690670
San Antonio, TX 78269

OR you may fax the form to us at 1-866-331-4362. Remember to keep a copy of any form that you send to our offices for your records.

If you need assistance to complete the form, please call 1-866-550-4736.

• Enrollment Form
  This form should be completed if you would like to become a member of Physicians Health Choice.
  English - PDF | Spanish - PDF
• Status Change Form
  This form should be completed if you have a change in your name, address, or telephone number.
  English - PDF | Spanish - PDF
• Complaint Form
  This form should be completed if you would like to file a complaint regarding service or quality of care issues such as unable to get an appointment in a timely manner, discourteous staff or physician, received unacceptable care, or lack of service.
  English - PDF | Spanish - PDF
• PCP Change Form
  This form should be completed if you choose to change your Primary Care Physician.
  English - PDF | Spanish - PDF
• Disenrollment Form
  This form should be completed if you move out of the service area and are no longer eligible to be a member of our health plan or if you want to disenroll from our plan and go back to the Original Medicare.
  English - PDF | Spanish - PDF

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