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Health Care Information Request Form

Blue Cross and Blue Shield of Oklahoma will send you a packet of information about Health Check plans.

Look over the materials and decide which Health Check plan best suites your needs.

What to do: Simply complete the form below, and a Health Check informational packet will be sent to you shortly.

Your Information:


Name:
Address:  
City:
State: OK Zip:
Phone Number: 
Age: Date of Birth:
(mm/dd/yyyy)
E-mail address: 
 

Are you currently a Blue Cross and Blue Shield of Oklahoma member?

 yes  no

If you would like to speak to one of our health inurance representatives, call toll-free at 1-866-303-BLUE (2583).