Get Mental Health Support Today – Covered by Medi-Cal
Self-Referral / Referral Form (Adults 18+)
Common questions
Do I need a referral from my doctor?
No. You can self-refer. Most people, families, and providers contact us directly using this form or by phone.
How long until I hear back?
We usually contact you within 1–2 business days to confirm Medi-Cal eligibility, medical necessity, and next steps.
What if I’m not sure I qualify?
You can still submit the form. If you want a simple explanation first:
read our step-by-step guide →
What insurance do you accept?
We accept Medi-Cal covered mental health services for adults 18+ in Los Angeles County, including the Antelope Valley.
Your Medi-Cal plan type is confirmed during intake — if you have active Medi-Cal in LA County, you can submit this form.