Registration Form

For New or Renewed Members of El Paso Health

Join one of our upcoming New Member Orientations and receive a $25 EPH Food from the Heart" gift card. You have 90 days from the date of your enrollment to register. Call us at 915-532-3778 if you have questions.

Restrictions and limitations may apply.

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Member Name

First Name*

Last Name*

Member ID Number*

Parent/Legal Guardian

First Name*

Last Name*

Contact Information

Address*

City*

State*

Zip*

Cell Phone*
Format:9151231234

Email

Number of people
who live in your home*

Select a date of your New Member Orientation*

If you need assistance or would like more information, please call us at 915-532-3778 or toll free 1-877-532-3778. We can answer your calls from 7:00 am to 8:00 pm Monday thru Friday.

*These fields MUST be filled out to register.

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