Forms

PacificSource Forms

  • Enrollment Form: Stop by the GTFF office to enroll.

Benefit Book

Medical Claim Form

Prescription Claim Form

Affidavit of Domestic Partnership

If you have questions, you can contact Lisa Hamilton, our health care administrator, at (541) 344-0832 or via email at lisa@gtff.net.

Forms and more can also be found on the Pacific Source Website: http://www.pacificsource.com/member/oregon/forms-and-materials.aspx