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New Patients

• New Patient Registration

• New Patient Registration (Spanish)

Sliding Fee Discount Program

• Sliding Fee Discount Program Application

• Sliding Fee Discount Program Application (Spanish)

• Sliding Fee Scale

Notice of Privacy Practices

• Notice of Privacy Practices

• Notice of Privacy Practices (Spanish)

Medi-Cal Program Applications

• CHDP Application (English)

• CHDP Application (Spanish)

• Family Pact Application (English)

• Family Pact Application (Spanish)

• Every Woman Counts Application (English)

• Every Woman Counts Application (Spanish)

• Presumptive Eligibility Application (English)

• Presumptive Eligibility Application (Spanish)

Stay Healthy Assessments

• SHA 0-6 months

• SHA 7-12 Months

• SHA 1-2 Years

• SHA 3-4 Years

• SHA 5-8 Years

• SHA 9-11 Years

• SHA 12-17 Years

• SHA Adult

• SHA Senior

Evaluacíon De Salud

• SHA 0-6 Meses

• SHA 7-12 Meses

• SHA 1-2 Años

• SHA 3-4 Años

• SHA 5-8 Años

• SHA 9-11 Años

• SHA 12-17 Años

• SHA Adultos

• SHA Personas Mayores

Adverse Childhood Experience (ACE)

• ACE Screening

• ACE Screening (Spanish)

• PEARLS Child Screening

• PEARLS Child Screening (Spanish)

• PEARLS Teen Screening

• PEARLS Teen Screening (Spanish)