Forms marked with * are interactive, so you can type information right into them.
You can also save the completed forms to your computer, print them and mail them to Priority Health at the address below.
1231 East Beltline Ave. NE
Grand Rapids, MI 49525
- Change PCP form*
- Change of status or plan form*
- MyPriority change of status or plan form*
- Member reimbursement form*
- HIPAA Authorization form*
- HIPAA Authorization form, Spanish*
- Revocation of HIPAA Authorization form*
- Revocation of HIPAA Authorization form, Spanish*
If you have questions, contact our customer service team by calling the number on the back of your membership card.