How to Enroll: Mobile Primary Care | Crown Health

Option #1 - Download to Complete

Step 1: Download the Enrollment Packet

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:

Enrollment packet – filled out completely (hand write or type)
Consent signatures – Patient, POA (Power of Attorney) or Legal Guardian signs all the required fields of this enrollment packet
Copy of Insurance Card(s)
Current Medication List – Request the most up to date list from patient's pharmacy
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

Copy of Insurance Card(s)
Current Medication List – Request the most up to date list from patient's pharmacy
POA/Guardianship documents

Step 3: Email additional documents to Crown Health

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