Umpqua Health Member

Documents & Forms

UHA Riders Guide

Learn more about getting free rides to your appointments.

NEMT & BCB Brochure

Learn more about getting free rides to your appointments.

GMR Appointment Verification Form

Use this form to request gas mileage reimbursement for non-emergency medical transport (NEMT).

Postal Prescription – New Customer Order Form

Use this form to sign up for medication by mail.

Postal Prescription – Quick Reference Guide

Review this guide to find tips and answers to questions for medication by mail.

UHA Comprehensive Formulary

Umpqua Health Alliance Formulary (Preferred Drug List) provides information on covered medications, coverage rules, and formulary status to help members and providers make informed pharmacy decisions.

Informed Consent Form – Consent to Sterilization for Members 15 – 20

Informed Consent Form – Consent to Sterilization for Members 15 – 20 (Spanish)

Informed Consent Form – Consent to Sterilization for Members 21+ (Spanish)

Informed Consent Form – Consent to Sterilization for Members 21+

Informed Consent Form – Hysterectomy Consent (Spanish)