ਗੁਪਤ ਸੰਚਾਰ ਬੇਨਤੀ ਫਾਰਮ

Use this form to ask the Alliance to send your confidential or sensitive health information to a different address, phone number, or email. This includes things like notices about medical services or other communications that include private health details. If approved, this request will only apply to Alliance communications with confidential information.

Do not use this form to:

• Make a one-time request
• Change your primary contact information
• Ask for all messages from the Alliance to be sent by email (we do not send general communications by email)

To update your regular contact information, complete the Update Contact Information Form

If you need help with this form, call Member Services.