Nominate Your Provider

Want to nominate your current primary care physician? Fill out the form below so we can reach out to ask your provider to join the Patient/Physician Cooperative network.


Once your nominated primary care physician joins, your co-payment will become $0!

Provider Nomination Form

I have joined the Patient/Physician Cooperatives by which I expect to gain access to medical and hospital services that is both affordable and by I might assure the quality of the services. I have in the past consulted with the physician I have named below, and I want to nominate that physician to be participating member physician of the Cooperative. The Cooperative is a means for me as a patient to pay fair, reasonable and manageable fees for my health care and for my group health insurance. And the nomination of my Primary Care Physician is an assurance of the quality of care I seek.

Thank you for nominating your primary care physician. We will reach out and let you know if they join the PPC Network.