Get Cahealthwellness

Filling out the Cahealthwellness form accurately is essential for ensuring your continuity of care. This guide provides step-by-step instructions to help you complete the form online with ease.

Follow the steps to successfully submit your continuity of care request.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred digital editor.
2. In Part 1, provide your member information including your first and last name, Medi-Cal ID number, date of birth, address, city, zip code, phone number, and the best time to call you.
3. In Part 2, enter the provider information by supplying the first and last name, phone number, address, city, and zip code of the provider you wish to continue seeing.
4. Indicate the treatment or service(s) you are currently receiving from this provider in the designated field.
5. Answer whether you have an appointment scheduled with the provider by selecting 'Yes' or 'No.' If you have an appointment, enter the date of your next appointment.
6. In Part 3, provide your signature, signifying your acknowledgment. If applicable, include the name of an authorized representative.
7. Save the changes to the completed form. You may also choose to download, print, or share the form as needed.

Complete your continuity of care request online today.