This section provides members with various types of forms available to them. Simply click on the form below, print out the form and mail directly to:
Physicians Health Choice
Attn: Member Service Department
P.O. Box 29429
San Antonio, TX 78229-9998
OR you may fax to us at 1-866-331-4362.
Remember to keep a copy of any form that you complete and send to our offices for your records.
>
Enrollment Form
This form should be completed if you would like to become a member of Physicians Health Choice.
Status Change Form (PDF)
This form should be completed if you have a change in your name, address, or telephone number.
>
Complaint Form (PDF)
This form should be completed if you would like to file a complaint regarding art of caring 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.
>
PCP Change Form (PDF)
This form should be completed if you choose to change your Primary Care Physician.
>
Disenrollment Form (PDF)
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 just want to disenroll from our plan and go back to the Original Medicare Plan.
The documents on our website are presented in PDF format. Click
Here to install Adobe Acrobat.
