Electronic Fund Transfer

Please click the link below to complete the EFT form electronically and digitally sign the form. Once complete, it will ask for your email address to confirm you completed the form. After confirmation, you will receive a completed copy of the EFT form.

To print or download the EFT Form, please Click Here. Printed forms should be submitted to providerservices@integranethealth.com or fax them to 832-320-7200.