Provider status update

To help us understand available healthcare resources for our members and how we may be able to assist you during this time, please let us know your status.

* Indicates a required field.

State *

Tax ID *

Practice/Provider name *

Is your practice open at the original location? *

Are you able to take appointment or walk-ins at the original location? *

If not at the original location, are you able to serve patients at an alternate location? *

Alternate location, if applicable *

Please share any other relevant information about your status *

Would you like to speak with someone at UnitedHealthcare regarding your recovery needs? *

Contact name *

Best contact method *

Contact phone *

Contact email *

Best time of day for outreach *