Request Personal Representative
Fill out this form to designate a personal representative. A personal representative can make health care decisions on your behalf. If you have questions, contact Member Services at 831-430-5505 or 800-700-3874, ext. 5505.
Contact Member Services
- Monday through Friday, from 8 a.m. to 5:30 p.m.
- Phone: 800-700-3874
- Deaf and Hard of Hearing Assistance
Alliance TTY Line: 800-735-2929
- Nurse Advice Line