Online Forms
Taking a participant to an appointment in your own vehicle and looking for gas reimbursement? Start here by registering as a driver.
Already been approved as a driver for gas reimbursement? After you’ve completed the trip, please fill out the Gas Reimbursement Form.
Printable Forms
This form must be completed by a healthcare provider indicating the most medically appropriate mode(s) for the member.
Register as a driver if you are planning to use your own vehicle to bring a Priority Health member to a healthcare appointment.
Complete this form if you have driven a Priority Health member to an appointment and are requesting reimbursement.
Click the button below to download a free PDF reader if you do not have a PDF reader installed on your computer.
