Fill and sign Cerfa 12485 online
Declares your chosen primary doctor (médecin traitant) to the health insurance system.
Cerfa 12485 at a glance
- Official name
- Déclaration de choix du médecin traitant (cerfa 12485*03, S3704)
- Issued by
- Assurance Maladie
- Country
- France
- Category
- Health
- Language
- French
- Who uses it
- Anyone covered by French health insurance who declares or changes their médecin traitant (regular doctor). For a child under 16, a parent makes the choice.
- Signature
Check with the recipient
You and your doctor both sign the form. Official pages do not say whether an electronic signature is accepted. Many doctors declare online during a consultation with your carte Vitale, which avoids the paper form.
- Instructions
- Official Assurance Maladie page
Cerfa 12485 (Assurance Maladie reference S3704) declares your médecin traitant, the regular doctor who coordinates your care. Open the official form from ameli.fr in BunnyDoc's free Sign PDF tool straight from this page, type into its fillable fields, add your signature and date, and download it. Your doctor must also sign it. Everything happens in your browser, so the file never leaves your device.
How to fill in and sign Cerfa 12485
Ask the doctor first
The doctor must agree to be your médecin traitant. Many doctors can make the declaration online during a consultation using your carte Vitale.
Fill in your details
If you use the paper form, type in your name, social security number and the details of the patient concerned.
Have the doctor complete and sign their part
Your chosen doctor fills in their details and signs, for example during a consultation.
Sign and date the form
Add your signature and the date. For a child under 16, a parent or person with parental authority makes the choice.
Post it to your health insurance fund
Send it to your CPAM, or to the MSA if you are on the agricultural scheme.
What you need before you start
- Your social security number.
- The agreement of the doctor you choose.
- The form from Service-Public.fr.
Why declare a médecin traitant?
According to Service-Public.fr, if you see a doctor who is not your declared médecin traitant, you are reimbursed less, with some exceptions such as children under 16, emergencies or being away from home. Gynaecologists, ophthalmologists, psychiatrists and stomatologists can be seen directly at the normal rate. You can change doctor at any time with a new declaration.
Cerfa 12485: frequently asked questions
Where do I send the médecin traitant form?
To your CPAM, or to the MSA if you are on the agricultural scheme.
Can my doctor declare it online?
Yes. Service-Public.fr says the doctor can submit the declaration online with your carte Vitale.
Can I change my médecin traitant?
Yes, at any time and without giving a reason. The new declaration cancels the old one.
Can I sign the form electronically?
Official pages do not say. Both you and the doctor sign, so the simplest route is often the doctor's online declaration.
Is BunnyDoc connected to the Assurance Maladie?
No. BunnyDoc is not affiliated with the Assurance Maladie or the CPAM. We link to the official form and give you a free tool to fill and sign it in your browser.
BunnyDoc is not affiliated with Assurance Maladie. Check that the recipient accepts electronic signatures.
Need someone else to sign? Send it for eSignature with BunnyDoc
Upload the filled-in form and send it to anyone for a legally binding eSignature, with an audit trail. 5 free signature requests every month.