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MyPCP

Thank you for being a member and taking steps to select your primary care provider.
Please fill out the fields below, provide your electronic signature and submit.
Let’s get started.

* Indicates a required field

    Give us some information about your membership:

    The First Name: field is required.
    The Last Name: field is required.
    The Member ID number** (11 digits, do not include hyphen): field is required.
    The Date of birth (mm/dd/yyyy): field is required.
    The ZIP code (5 digits only): field is required.

    Select your primary care medical group

    Choose one:
    The Choose one: field is required.

    Review your information and sign:

    The Electronic signature (please type your name): field is required.
    By typing my name above I am providing authorization to electronically sign this request and warrant that all information provided is true, complete and accurate.
    The Authorization: field is required.

    **How to find your Member ID number (Opens in new tab/window)