Primary Care Provider (PCP) Selection Form - Gold Coast Health Plan - goldcoasthealthplan 2026

1. Click ‘Get Form’ to open the Primary Care Provider (PCP) Selection Form in the editor.
2. Begin by locating your desired doctor or clinic in the provided directory. Once you find them, write their name in the designated space labeled 'Print Physician or Clinic Name'.
3. Next, identify the four-digit ID number that appears in bold next to the physician's name. Enter this number in the space marked 'Physician or Clinic ID number (4 digit)'. Remember, all doctors within the same clinic share this ID.
4. Fill out your personal information including your Date of Birth and Member Name in the respective fields.
5. Finally, sign and date the form at the bottom to confirm your selection before mailing it back using the prepaid envelope provided.

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