Primary care physician selection form

Please complete this form to select or change your primary care physician. We will mail a Sharp Health Plan member ID card with your updated provider information to you within 7 - 10 business days of processing this form. If you have any questions or need immediate assistance, please contact our Customer Care team at 1.858.499.8300 or toll-free at 1.800.359.2002, from 8 am to 6 pm, Monday through Friday. 

Are you a current patient of the doctor you are requesting?*

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