Download & Complete the Fidelity Health Savings Account (HSA) Application
Open, read, and print the application to send to Fidelity
Fidelity HSA Application (PDF)
Complete, sign in ink, and mail your application to the address included in the application.
If you are unable to access the PDF application, you can have a paper copy mailed to you by calling 800-343-3548.
To view the account's supporting documents, please return to the supporting documents page.