Enrollment Forms

All of our forms are in PDF format and you must have Adobe Acrobat Reader, or a similar PDF viewer installed on your computer or device to view them.

For manual completion, please print the form.

Complete the form making sure to fill in all necessary and requested information. It is very important that you read each form thoroughly and provide all additional requested information to accompany the form, such as receipts and/or EOB's. If the form or any additional requested attachments are incomplete, the form cannot be processed until all requested information is received.

Mail the completed form and all requested supporting documentation (if any) to:

Integrity Administrators, Inc.

 ATTN:  Administration Department

P.O. Box 13128

Sacramento, CA 95813-3128

Fax: 916.921.3383

Email: admin@integrityadmin.com