New Provider Application Request
The CHP Group offers prospective providers the opportunity to request an application through a secure e-mail and, in some states, the ability to complete your application online. If you are a provider wanting to join CHP, please complete our short application request form below. We will contact you within one business day.
We want you to consider joining CHP and our network of quality providers. If you have questions please call us toll free at 800-449-9479 x501 weekdays from 8:00 am to 5:00 pm. Or e-mail us any time at firstname.lastname@example.org.