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Medical Provider Nomination

GEHA members, providers or office personnel may use this form to nominate a physician or hospital to the GEHA provider network. Complete the information below and select Submit Form to send this form by email to GEHA.

If you have any questions, please contact GEHA's Customer Service department at (800) 821-6136. Please complete all the blanks on this form. This information helps us process your request. The nomination process may take three to six months. Not all providers who are nominated will become participating providers in the GEHA provider network.