For Health Professionals
Contracted Provider Forms
- PlanLink Access Request Form
- 2024 Authorization Request Form
- Claim Submission Information
- Transition of Care/Continuity of Care Form
If you are interested in becoming a contracted provider with Kelsey-Seybold Clinic please submit a Letter of Interest (LOI).
Please include the following information in your LOI:
Letters can be submitted via:
Email: affiliateproviders@kelsey-seybold.com
Fax: (713) 442-2775
Kelsey-Seybold Clinic
Attn: Network Development
11511 Shadow Creek Parkway
Pearland, Texas 77584
Provider selection is based on numerous factors. You will receive notification regarding the Plan's decision to enter into an agreement generally within six (6) weeks of submission of the LOI.