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How to Enroll

Option #1 - Download to Complete

Step 1: Download the Enrollment Packet

Download

Step 2: Complete all forms and collect documentation

All of the following must be provided in order for us to complete the enrollment and schedule a visit:

  1. Enrollment packet – filled out completely (hand write or type)
  2. Consent signatures – Patient, POA (Power of Attorney) or Legal Guardian signs all the required fields of this enrollment packet
  3. Copy of Insurance Card(s)
  4. Current Medication List – Request the most up to date list from patient's pharmacy
  5. POA/Guardianship documents
Step 3: Send all documents to Crown Health

Option #2 - Online Enrollment

Step 1: Request Docusign Packet
Send us an e-mail at enrollments@crownhealthus.com to request a Docusign enrollment and consent form. 
 
Step 2: Gather additional documentation

Make copies or scan the following 

  1. Copy of Insurance Card(s)
  2. Current Medication List – Request the most up to date list from patient's pharmacy
  3. POA/Guardianship documents
Step 3: Email additional documents to Crown Health

Email all documents gathered in Step 2 to enrollments@crownhealthus.com

 
Please Note:
  • The enrollment process generally takes 2 weeks; once complete, the patient will be scheduled to be seen at the provider's next visit to the community.
  • The patient will continue with their current primary care provider until seen by Crown Health.

Please contact us if you have questions regarding enrollments at 888-674-5871 ext. 670 or by email enrollments@crownhealthus.com.