MyAdvocate – Personal Health Assistant

Healthcare is complicated. Getting help doesn’t have to be – thanks to MyAdvocate

Submit the form below to connect with a Personal Health Assistant

To get started, please complete the form below to send a message to a Personal Health Assistant or call 833-968-1775 (24/7 intake)

Name*
First Last
Email*
Phone*
Date of Birth*
MM slash DD slash YYYY
Preferred method of contact*
- Email
- Phone
Preferred time of day to call
Select a General Issue*
Type of doctor that needs to be found or the condition that needs to be treated
Preferred Zip Code of search (may be different than home address)
ZIP / Postal Code
Facility name or address
Preferred time of day
Contact information for the provider/facility that the records are being transferred from
Contact information for the provider/facility that the record is being transferred to
When do the records need to be transferred by
MM slash DD slash YYYY
Member ID number
Date of Service and provider name (to work with insurance)
Advocate Information
Advocate Name
Company Name*
Issue Detail
CAPTCHA