Network Enhancement Request Form

Berkshire Health Partners (BHP) offers a comprehensive network of physicians and services for your health care needs. If your healthcare professional is not in the BHP’s Provider network, please contact us at (610) 372-8044 or complete the form below. We will be happy to contact the provider office and invite them to participate in BHP. If the provider opts to become a participating provider of our network, they must go through a strict credentialing process which usually takes a few weeks. While we cannot guarantee the participation of your referred provider, we can contact you when provider is part of the network.

Thank you for your referral.

Providers Name:
If the provider is a physician (check one):	Family Practice Internal Medicine Pediatrician OB/GYN Other:
Provider’s Address:
Provider’s Phone:
Your Name:
Your Email:	Please include your full address and/or phone number so we notify you.
Your Home Address (optional):
Your Phone (optional):
Your Employer’s (Company) Name: