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Members! Before submitting a request below, please access your account, or register for an account. Find answers to many common questions like changing your password or requesting a new ID card.

Do you need more information or have a question? If you have a life threatening emergency, please contact 911.

Required fields are marked with an asterisk (*).

First Name *

Last Name *

If Member, enter your Birth Year

Street Address

City

State

Zip Code

Phone

Email *

Question/Comment *

First Name *

Last Name *

County *

Phone

Email *

Question/Comment

First Name *

Last Name *

Phone

Email *

Question/Comment *

First Name *

Last Name *

If Member, enter your Birth Year

Specialty of Doctor * e.g. Family Practice

Address or Zip Code for Search: * e.g. 1234 Home Way, Sacramento, CA 95820

Mile radius: * e.g. 10

Delivery Preference: * Mail Fax Email Select your preferred delivery method

Mailing Address:

Email Address:

Fax Number:

First Name *

Last Name *

If Member, enter your Birth Year

Specialty of Doctor * e.g. Family Practice

Address or Zip Code for Search: * e.g. 1234 Home Way, Sacramento, CA 95820

Mile radius: * e.g. 10

Delivery Preference: * Mail Fax Email Select your preferred delivery method

Mailing Address:

Email Address:

Fax Number:

First Name *

Last Name *

If Member, enter your Birth Year

Specialty of Doctor * e.g. Family Practice

Address or Zip Code for Search: * e.g. 1234 Home Way, Sacramento, CA 95820

Mile radius: * e.g. 10

Delivery Preference: * Mail Fax Email Select your preferred delivery method

Mailing Address:

Email Address:

Fax Number:

First Name *

Last Name *

Street Address

City

State

Zip Code

Phone

Email *

Question/Comment *

Name of Media Outlet *

First Name *

Last Name *

Email Address *

Phone

How can we help? *

First Name *

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Email Address *

Phone

How can we help? *

You can also reach us by phone.
Member tip: Check the back of your ID card for your phone contact information.

Last Updated: 08/23/2024

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Do Not Sell My Personal Information

Choosing Who Can See My Confidential Medical Information

Do Not Sell My Personal Information

Choosing Who Can See My Confidential Medical Information