Provider Downloads

At US Family Health Plan, we believe it’s extremely crucial to keep our provider network up to date with information and resources that will allow them to continue the great service that they provide to our members. Below you will find important information for our providers.

Outpatient Referral Form

  1. Click here to print out the Outpatient Referral Form
  2. Fill out the form, leaving the Form Number box blank
  3. Make 1 copy. Give the original to the patient, and keep the other copy for office records

Service Request Form

The Service Request Form is intended for providers to submit their patient’s authorization requests to eQ Health for processing.

In order to request service, you will need to fill out the Service Request Form and submit it.

Fill out the form here