Primary care physician selection form

Complete this form to select or change your primary care physician. The change will be effective on the first day of the following month.

If you are choosing a primary care physician (PCP) in a different plan medical group — for example, you are switching from a doctor in Sharp Rees-Stealy to a doctor in the Sharp Community Medical Group — your current referrals or prior authorizations for specialists, special supplies or equipment will be voided. You must ask your new PCP for new referrals or prior authorizations.

You should receive a Sharp Health Plan member ID card with your updated provider information five to seven business days before the effective date. 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?*

* Required field.