Primary Care Physician Selection Form

Upon enrollment, members must select a primary care physician (PCP) close to home or work to allow reasonable access to care. A member's PCP is responsible for coordinating medical care. Please use this form to select a PCP.

First Name:

Last Name:

Your Company Name:

Birthdate:

mm/dd/yyyy

Phone:

xxx-xxx-xxxx

Email:

Use our provider search tool to find a participating PCP near you: choosewha.com/directory.

PCP Name:

PCP's Medical Group:

Thank you for submitting a PCP selection for June 1, 2025. If we do not receive a PCP selection or your chosen PCP is not accepting new patients, we will automatically assign you a PCP. It is important to note, you can change your PCP anytime by contacting WHA or once enrolled, through a MyWHA Account at mywha.org. Any requested changes will be effective first of the month following your request. If you have any questions or need assistance, contact WHA’s Sales team at 916.563.2266, Monday-Friday (excluding holidays) from 8 a.m. to 5 p.m.

Si necesita ayuda o para enviar su PCP, comuníquese con los Servicios para Miembros de WHA.