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Medi-Cal Mail-In Application Form

Medi-Cal Application Instruction LogoThe Medi-Cal Mail-In Application is available in 11 languages in a View and Print Version. (See Chart Below)


Please mail your completed Medi-Cal Mail-in Application to your nearest County Social Services Office.

Should you require additional assistance after reading the Mail-In Instructions, contact your nearest
County Social Services Office.

 
NOTE: Some links on this page are documents in Adobe Acrobat Portable Document Format (PDF); unless indicated are smaller than 2 MB. PDF documents require Adobe Reader. If you need to install or upgrade to the latest version, click the “Download Free Readers”.

Language

Introduction

Application

Instructions

Armenian View View View
Chinese View View View
English View View View
Farsi View View View
Hmong View View View
Khmer View View View
Korean View View View
Lao View View View
Russian View View View
Spanish View View View
Vietnamese View View View

Last modified on: 4/16/2013 9:48 AM