Forms

Request a Provider Directory or a Pharmacy Directory

Complete this form to get a Provider Directory or a Pharmacy Directory mailed to you.

Pharmacy forms

Enrollment and member change forms

Privacy forms

Because Fallon Health is dedicated to protecting your privacy, we are strict about who can see your information. However, there may be times that you want to allow certain other people to see your information or perhaps get a copy for yourself. Fallon makes this easy for you to do by printing off the appropriate form and submitting it according to the directions on the form.

Fallon Senior Plan is an HMO/HMO-POS plan with a Medicare contract. Enrollment in Fallon Senior Plan depends on contract renewal. To view the PDF files above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer. (This link takes you away from the Fallon Senior Plan website.)

H9001_F_2017_21 Approved 10172016
The information on this page was last updated on 10/1/2016.

Call us toll-free at 1-888-340-5504 (TRS 711), 8 a.m.–8 p.m., Monday–Friday. (Oct. 1–Feb. 14, seven days a week.)

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