Digital Form 17 (Payment Commitment Form)

Caring for your health isn’t just about providing advanced medical services — it’s also about ensuring your comfort and convenience.

No more running around, no more hassle. Leumit customers with a referral can independently request a Form 17 (payment commitment form) via the Leumit website or app — and receive a response within five business days (in most cases, even instantly!).

How to issue a Form 17:

1. Get a referral from a Leumit doctor, an external doctor, a hospital, or an institute.
2. Choose where you wish to receive the test or treatment, under the Form 17 commitments category on the Leumit website or app (התחייבות טפסי 17).
3. Issue the commitment (Form 17) by clicking “יצירת התחייבות חדשה" (Create a new commitment) or "יש לי הפניה מרופא חיצוני" (I have a referral from an external doctor) or by clicking the following link:
   Issue a Form 17

When will I get a response?

The digital system ensures quick and efficient handling of requests:

Commitments that don’t require approval are issued immediately.

Commitments that do require approval will be processed within five business days.

How will I receive the response?

You’ll get an SMS with the answer to your request — as well as a notification on the Leumit website and in the app.

Through the Leumit website or app you can:

• Submit a commitment request
• Track your request status
• View the commitment you submitted and all past/pending commitments
• Print the commitment
• Send the commitment by email or fax
• See all valid referrals currently in the system