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.
2019 Plan Forms
- Formulario de Inscripcion Individual
- Formulario de Cambio de Plan
- Formulario de Opcion de Pago
- Formulario de Confirmacion del Alcance de la Cita
Appointing a Representative
An appointed representative is a relative, friend, advocate, doctor, or another person who is authorized to act on your behalf in obtaining a grievance, coverage determination or appeal. If you would like to appoint a representative, both you and your representative must complete the form below and mail it to Community Health Plan of Washington.
Completed forms can be mailed to:
Community Health Plan of Washington
ATTN: Community HealthFirst
1111 Third Avenue, Suite 400
Seattle, WA 98101