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Medi-Cal Assessment
For: Married Applicants

Please complete the below Medi-Cal Assessment before booking an appointment. You will be Booking a Phone Appointment to discuss your completed Assessment. Please proceed with the assessment only if you do Not currently have Medi-Cal coverage.

Assessment Instructions:
The first few lines of the assessment are for the contact information of the person filling out the assessment. The remainder of the form is for information on the Medi-Cal Applicant.
 
Medi-Cal Assessment
Are You Currently on Medi-Cal? Required
Veteran Required
Mental Capacity Required
Current Residence (meaning where is resident housed?) Required
Life Insurance Required
Do you own a Home? Required
In the Last 30 Months was Anything Required
Spouse / Mental Capacity Required
Current Residence
Spouse / Do you Own a Home
Spouse / In last 30 Months was Anything Required
Please wait after submitting the Assessment for the Booking Screen (page) to appear. 

Book your appointment at that time.

We look forward to assisting you.
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