Contact Information Send Successfully

Your form was successfully submitted. A pdf copy of the application was also sent your email address. An certified Covered California / Medi-Cal Enroller will be calling you within 1 business day. Download Now: pdf PDF files can be viewed and saved using Adobe Reader software. To view a file, click on the hyperlink. When saving a file, be sure to use Save function of Adobe Reader rather than the web browser’s save. To save the file without viewing it first:

  • Right click on the title link.
  • Select “Save Target As” (Internet Explorer) or “Save Link As” (Firefox / Mozilla / Netscape) when presented with a menu (if your mouse is configured for left handed operation use the left mouse button).
  • Use Adobe Acrobat Reader to open the file directly after downloading.

All of our files are verified prior to posting. If you have difficulty viewing a PDF file, it may be due to software settings, configuration problems, download failures, or other issues. Troubleshooting information can be found within Adobe’s support knowledgebase ( Document 325875) when PDF pages don’t appear in the web browser window.