CHIP Forms

Value Added Services

Our VAS gift card forms can now be found within our MyCookChildren's Member Portal. You can access these forms by signing up and logging into the portal below.

MyCookChildren's Member Portal

Once signed up and logged in, the forms can be located under VAS Forms.

Forms

The following forms are available to download in PDF format.

• Provider Change Request Form (Authorizations)
• Request to Authorize Account Access

We're here to help

Please call Member Services if you have any questions about these forms at 1-800-964-2247. Monday - Friday from 8am - 5pm.