Fabricate PCP Form Upload

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Fabricut Primary Care Provider Form Secure Submission

Upload your completed Primary Care Provider Form by 11/30/2026.

Before you submit your form, please complete the following steps:

Print clearly and review your form to ensure all applicable information is complete.
Confirm the date of physical is within the following date range: 6/1/2026 - 11/30/2026
Be sure to provide a valid email address so we can communicate with you regarding the status of your form.
Ensure you and your physician have signed the form. Both signatures are required.

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Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.