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South Country Health Alliance | Directory Request Form

Provider Directory Request Form

Use this form to request a printed copy of one of the provider directories from South Country Health Alliance.
Please complete the form below.
    If "Other" please describe.
  • The following main directories include primary care, specialty care, urgent care, hospitals, nursing homes, behavioral health (mental health and substance use disorders), audiology, vision, dental, physical therapy, chiropractic care, and pharmacies.
  • Currently there is only one subdirectory available.
  • For printed directories, you must enter your name and mailing address. For electronic directories, enter your email address. Please note that you can download directories directly from the website. Because our main directories are large electronic files, we may not be able to email them to you. In that case, we will send you a link to download them.

  • Your phone number is optional. We will not use this number for any other purpose except to contact you if we have trouble sending you a directory.
  • If our directory files are too large to email, we will send you a link to download them. You can also download them directly by using the links on the directory page.

    We may contact you by email if we have trouble sending a printed directory to your address.
  • This form will be sent securely to Member Services at when you click "Submit." If you need help or have questions, call Member Services at 1-866-567-7242 (TTY users call 1-800-627-3529). The call is free.