USFHP: US Family Health Plan

Please do not use this form for submitting personal health information or complaints. Instead, please call us at the 1-800 numbers listed to the left.

1. Select the area of service in which you live:

2. Select the subject of your concern and type your question:

3. Your Personal Contact Information

First Name*:

Last Name* :

Address:

Address 2:

City:

State:

Zip:

Day Phone*:

Other Phone *:

Email*:

Sponsor's ID
(Last 4 digits):

Request a presentation to your group or organization for active duty or retired military families:

Check here to receive a copy of this email request.

Please do not use this form for submitting personal health information or complaints. Instead, please call us at the 1-800 numbers listed to the left. 1. Select the area of service in which you live:
2. Select the subject of your concern and type your question:
Type your question here.
3. Your Personal Contact Information
First Name*:
Last Name* :
Address:
Address 2:
City:
State:
Zip:
Day Phone*:
Other Phone *:
Email*:
Sponsor's ID (Last 4 digits):

Request a presentation to your group or organization for active duty or retired military families:
Check here to receive a copy of this email request.

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