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
- Enrollment Application
- Formulario de Inscripcion Individual
- Plan Change Form
- Formulario de Cambio de Plan
- Payment Option Form
- Formulario de Opcion de Pago
- Scope of Appointment
- Formulario de Confirmacion del Alcance de la Cita
- Authorization to Release Health Care Information
- Medical Claim Form
- Appointment of Representative | Nombramiento de un Representante
- Pay Your Bills Online
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