Form preview

Get the free Tricare For Active Duty Members and Their Dependents ...

Get Form
CHILD PATIENT REGISTRATION Forename of person filling out this form (if not patient) PATIENT INFORMATION Name Sex Age Birth Date / / Date of appointment Who referred you to our office? Who is responsible
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign tricare for active duty

Edit
Edit your tricare for active duty form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your tricare for active duty form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing tricare for active duty online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Use the instructions below to start using our professional PDF editor:
1
Log in to your account. Start Free Trial and register a profile if you don't have one yet.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit tricare for active duty. Add and change text, add new objects, move pages, add watermarks and page numbers, and more. Then click Done when you're done editing and go to the Documents tab to merge or split the file. If you want to lock or unlock the file, click the lock or unlock button.
4
Get your file. When you find your file in the docs list, click on its name and choose how you want to save it. To get the PDF, you can save it, send an email with it, or move it to the cloud.
With pdfFiller, it's always easy to work with documents.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out tricare for active duty

Illustration

How to fill out tricare for active duty

01
To fill out Tricare for active duty, follow these steps:
02
Obtain the necessary paperwork, including the TRICARE Enrollment Application form (DD Form 2876) and any other required documents.
03
Fill in your personal information, including your name, rank, Social Security number, and contact information.
04
Provide information about your active duty status, including your branch of service and military ID number.
05
Choose your desired Tricare plan option and indicate any dependents you wish to enroll.
06
Complete the sections related to your health benefits, such as healthcare provider preferences, primary care manager selection, and any additional coverage you may have.
07
Review the completed form for accuracy and sign it.
08
Submit the form and any supporting documents to the appropriate Tricare office or mailing address.
09
Follow up with Tricare to ensure your enrollment is processed correctly.

Who needs tricare for active duty?

01
Tricare for active duty is needed by all active duty members of the military.
02
This includes individuals serving in the Army, Navy, Air Force, Marine Corps, Coast Guard, and the Commissioned Corps of the Public Health Service and the National Oceanic and Atmospheric Administration (NOAA).
03
Active duty members include those on active duty for more than 30 consecutive days, as well as activated Reserve and National Guard members.
04
Family members and dependents of active duty members may also be eligible for Tricare coverage.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.2
Satisfied
24 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

The premium pdfFiller subscription gives you access to over 25M fillable templates that you can download, fill out, print, and sign. The library has state-specific tricare for active duty and other forms. Find the template you need and change it using powerful tools.
Create your eSignature using pdfFiller and then eSign your tricare for active duty immediately from your email with pdfFiller's Gmail add-on. To keep your signatures and signed papers, you must create an account.
Use the pdfFiller mobile app to complete and sign tricare for active duty on your mobile device. Visit our web page (https://edit-pdf-ios-android.pdffiller.com/) to learn more about our mobile applications, the capabilities you’ll have access to, and the steps to take to get up and running.
Tricare for active duty is a health care program for active duty members of the military and their eligible family members.
Active duty members of the military and their eligible family members are required to file for Tricare for active duty.
Tricare for active duty can be filled out online through the Tricare website or by visiting a Tricare office in person.
The purpose of Tricare for active duty is to provide affordable and accessible healthcare for military personnel and their families.
Information such as personal details, military status, and health insurance details must be reported on Tricare for active duty forms.
Fill out your tricare for active duty online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.