Provider Contact Form
Please complete the requested information below. Note that identified fields with an asterisk (*) are required. When you are finished, click on the 'Submit' button
This form will send your message to MHN as an email. The email is not encrypted and is not transmitted in a secured format. By communicating with MHN through email, you accept associated risks. MHN does not accept responsibility or liability for any loss or damage arising from the use of email. To ensure the safety of your PHI, please send us a message through the Secure Member or Provider portal.