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Application / Renewal Form (DHS 9042) – English - PDF file

Solicitud / Renovación Forma (DHS 9042-SP) – Español - PDF file

Written Documentation of Patient's Medical Records (DHS 9044) – English - PDF file

Documentación Escrita de los Expedientes Médicos del/de la Paciente (DHS 9044-SP) – Español - PDF file

Authorization to Use and Disclose Protected Health Information (PHI) (F346-531 MMIC) – English

Application Appointment Checklist – English

Application Appointment Checklist – English - PDF file

CDPH 9043 (English Version)
Application / Renewal Form (DHS 9042) – English - PDF file
Application / Renewal Form (DHS 9042) – English - PDF file