Applications for Licensing and/or Certification of a Health Facility
The following application forms and documents are organized by the facility type. In addition to the listed documents, a check made payable to the “California Department of Public Health” for the applicable licensing fee must accompany the required forms before your application will be processed.
How to apply for specified health programs simultaneously:
To learn about the process and obtain the forms to simultaneously apply for the following health programs as you apply for a clinic license, please reference the sites and documents below.
Adult Day Health Center:
Chronic Dialysis Clinic (End Stage Renal Dialysis):
General Acute Care Hospital:
Home Health Agency:
Intermediate Care Facilities for the Developmentally Disabled:
Management Company - Hospital:
Please submit completed forms to your local Licensing and Certification District Office
Management Company - Skilled Nursing Facility or Intermediate Care Facility:
Primary Care Clinics:
Skilled Nursing Facilities:
For other facility types not listed above, please contact your local Licensing and Certification District Office to obtain an application to license and/or certify a health facility.