NEEDS REQUEST Member Name* First Last Member Phone*Member Email* Need Type*Regular Needs RequestMaternity Needs RequestAlternative Medicine RequestSpecial Needs RequestPreventive Needs Request Preventive needs must be submitted by the provider within the PHCS network. Your provider can submit the request electronically or by mail.Other Coverage Medicare Medicaid Insurance plan Auto insurance (if auto accident) Select all that might apply.Need Description*Please provide the details for your medical need to be shared with the community. Supporting Files (if any)Upload any supporting files for your medical need. Drop files here or CAPTCHA Enjoy Medical Cost Sharing Membership All of what you need in a medical cost strategy, great savings, and like-minded individuals. Enroll Online
