Select from the following forms to print, complete, and mail back to us.

If you do not see the form that you need or have questions about any of these forms, please contact Customer Service, 8:00 a.m. to 8:00 p.m., 7 days a week, at 1-800-942-0247 (TTY Relay: Dial 7-1-1). You will need Adobe Acrobat Reader to view the PDF documents on this website. Download Adobe Acrobat Reader for free. 

Click on the form title below:

2018 Plan Forms

Other Forms

Pharmacy and prescriptions drug forms can be found on the Prescription Coverage page.

Health Information disclosure and privacy forms can be found on the Rights and Privacy page.

Completed forms can be mailed to:

Community Health Plan of Washington
ATTN: Community HealthFirst
1111 Third Avenue, Suite 400
Seattle, WA  98101