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The forms listed below are available for download and print as PDFs. In order to open them you must have Adobe Reader installed.
Patients may meet eligibility and receive assistance towards the payment for services from the following agencies:

  • Family PACT - Family planning and reproductive health at no cost to low-income men and women, including teens.

Family Pact

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    Promote reproductive health and reduce unplanned pregnancy /STD 

CHDP Program

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    Complete health assessments for early detection and disease prevention

Covered California

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    Easy-to-use marketplace for federal Patient Protection and Affordable Care Act