Please upload your completed enrollment form here:

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Locate completed PDF enrollment file on your computer (desktop)

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You may mail or fax this information to:

Western Washington patients

1) FAX to: 206-694-2291

— OR —

2) UploadFor your convenience, you can upload your completed Enrollment Form & other documents here

— OR —

3) MAIL to:
Crown Health
23745 225th Way SE Suite 201
Maple Valley, WA 98038

Eastern Washington patients

1) FAX to: 509-232-5795

— OR —

2) UploadFor your convenience, you can upload your completed Enrollment Form & other documents here

— OR —

3) MAIL to:
Crown Health
12623 E Sprague Avenue Suite 6
Spokane Valley, WA 99216

 

Or email to: rachaelb@crownhealthus.com