Provider Change Fax Guide
How to Fax Healthcare Provider Change Forms
Switching doctors or clinics often involves a provider change form. This guide shows you how to fax those administrative forms online.
Many health plans require a provider change request form when you move to a new primary care provider or clinic. These forms are usually administrative and focus on plan details, effective dates, and provider information—not clinical records.
Send a provider change form
Use the on-page form to fax administrative provider change paperwork.
01
Get the Provider Change Form and Fax Instructions
Download the official provider change form from your health plan or employer benefits portal and note the exact fax number they specify.
02
Complete Only the Administrative Sections
Fill in member information, plan details, new provider information, and signatures as required. If the form requests medical history, follow your plan’s secure process for that portion instead of faxing it via TidyFax.
03
Fax Your Provider Change Form Online
Scan or save your completed provider change form as a PDF, upload it using the secure form on this page, and send it directly to the health plan’s fax number.
Related Resources
Send a Provider Change Request by Fax
Quickly fax your provider change form using the on-page form.
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Important: TidyFax is a general-purpose online fax service. This form is not intended for transmitting HIPAA-regulated medical information. Please avoid sending PHI or confidential patient data.