Careers Community Outreach About Us Contact Us Search
You are here: Contact Us / More Information
If you are contacting us regarding a matter that requires immediate attention, please call us at 888-257-1985. If you need emergency care, call 911 or go to the nearest emergency room right away. Questions or comments regarding medical conditions or treatments should be discussed with your health care provider by phone or in person, not sent via this request form.
First name*:
Last name*:
Address*:
City*:
Zip*:
Do you have an e-mail address*:
E-mail address:
Please enter at least one phone number.*
Phone (Home):
Phone (Cell):
Date of Birth*:
Do you currently have insurance?:
Are you a Commonwealth Care Member?:
How did you hear about us?:
How do you want to be contacted?:
Language you prefer?:
While Network Health welcomes your comments, please be aware that this information is being sent to us via e-mail and is not secure.Please read the following statement and check the box below before submitting this page:By checking this box and submitting this page, I give Network Health permission to contact me about the answers I have typed in the box above.
© 2009 Network Health | Network Health Together and Network Health Forward are trademarks of Cambridge Health Alliance. | Terms of Use and Privacy Policy | site map
Call us at 888-257-1985 for information in other languages.