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Two ways to Enroll

Download and Complete

Step 1: Complete and return Enrollment Packet

Download

Please review the complete Crown Health Patient Agreement prior to completing the Enrollment Packet. 
Step 2: Gather all required 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

Online Enrollment

Step 1: Complete online form
Enroll Online
 
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.