Enroll

Confidential & Personalized Care

Thank you for your interest in Tria Health! Before you get started on the enrollment form, please have the following information available:

The current prescriptions, over-the-counter medications and supplements you take.
Your primary physician’s name and contact information.

It should take you approximately 15-20 minutes to complete. Once you’ve submitted your enrollment form, you will be contacted by a Tria Health Member Advocate to schedule your first appointment. If you have any questions, please call our Tria Help Desk at 1.888.799.8742.

Please note: You may submit this form at any time as long as you’ve completed all required fields. A Tria Health Member Advocate will follow-up with you to receive any incomplete information.

First Name

Last Name

Email Address

Phone Number

Date of Birth

Zip