Epic application 2025

1. Click ‘Get Form’ to open the epic application in the editor.
2. Begin by entering your personal information in the 'Who is applying?' section. Indicate whether you are applying for yourself only or for both you and your spouse.
3. Fill in your last name, first name, middle initial, date of birth, and social security number. Ensure all details are accurate and clearly printed.
4. Provide your current address where you live (not a P.O. Box) along with your mailing address if different. Include city, state, and ZIP code.
5. Report your total income for the previous calendar year. If married and living together, report combined income; otherwise, report only your income.
6. Review the certification statement at the bottom of the form. Sign and date it to confirm that all information provided is correct.
7. If applicable, complete the optional authorization section to allow EPIC to disclose information to designated individuals involved in your healthcare.
8. Once completed, save your changes and submit the application via mail or fax as instructed on the form.

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