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Medi-Cal Assessment
For: Single 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 is 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?
Mental Capacity
Current Residence (meaning where is resident housed?)
Life Insurance
Do you own a Home?
In the Last 30 Months was Anything:
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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