Washington Health Program
Apply Online Registration Page

For More Information or to Obtain a Quote call
1-888-957-5001 Toll-free
or Fill Out Form Below to Apply for Coverage

All Washington residents can apply for coverage. Citizenship is not required.
For all individuals or family members you are planning to enroll:
Red fields are required.

Enter Full Legal Name *

Date of Birth (mm/dd/yyyy)*

Use box below to list additional family members

Email Address:

Phone Number:

If you want help filling out the application or have any questions, please tell us below.

OR call us toll-free at 1-888-957-5001 during normal business hours.

If nothing appears to happen when you click the "Apply Now Online!" button, please scroll up and check for error messages in the form fields.