Choose a language to download the application:
Did you know you could sign up online?
Feel free to apply by going to My Peacehealth.
You can send us questions via My PeaceHealth or by contacting a Customer Service Representatives at 877-202-3597.
You can fax, email, or mail your completed applications to:
- Fax: 360-729-3047
- Email: email@example.com
- Mail: PeaceHealth, PO Box 748632, Los Angeles, CA 90074-8632
- In person: Applications may be taken to your local PeaceHealth Provider (In response to COVID, please check with your local provider before attempting to drop off)
Be sure to keep a copy for yourself.