Digital Form 17 (Payment Commitment Form)
Leumit customers can submit a request for a Form 17 and issue it directly through the Leumit website or app.
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:
- Get a referral from a Leumit doctor, an external doctor, a hospital, or an institute.
- 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).
- 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
Leumit Online
Leumit offers a range of digital tools and services to help you access healthcare — anytime, anywhere.
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To enjoy Leumit's digital services, download the app and complete your registration.
A wide range of medical and administrative services are waiting for you — all in one place.
