Forms for Clients
- Behavioral Wellness Appeal Form English | Spanish
- Behavioral Wellness Grievance Form English | Spanish
- Request for Change of Care Provider/ Clinician (English)
- Request for Change of Care Provider/ Clinician (Spanish)
- State Fair Hearing Information English | Spanish
- Drug Medi-Cal State Fair Hearing Information (English)
- ROI - Consent for Release of Patient Information or Records English | Spanish
- Request a Second Opinion English | Spanish
- Advance Directives for Medical and/or Psychiatric Healthcare English | Spanish
- Application to Serve as a Voting Member, Consumer and Family Member Advisory Committee (English and Spanish)
Also see:
HIPAA Information | Beneficiary Information | Patients' Rights