Forms and Documents

BEFORE YOU APPLY

Our Online Portal is now available, click the link below. Please have the following documents ready: Doctors Attestation form signed by your doctor or a Medical Summary from your health care provider and a government issued ID that states you are a North Carolina resident.

If you are a member of the EBCI you must have the latest version of the Enrollment Card which includes a issued and expiration date.

Review photo requirements in the attachment below before you proceed.

If you are applying as a Designated Primary Caregiver, please include a copy of your Health Care Power of Attorney legal documents.

We are only accepting payments via cash, check, or money order and can be mailed or paid in person at the addresses listed below:

Office: 620 Casino Trail, Whittier NC 28789
Mail: P.O. Box 549, Cherokee NC 28719

Email: info@ebci-ccb.org

 

*Applications will not be considered complete until we receive payment.*

Additional Files:

Doctor Attestation [PDF]

Info About Patient Cards [WORD]

Photo Requirements [IMAGE]