Client Application Forms
Client Application Forms by Client Type
Adult Uninsured (Including Medicare Without Part D)
Adult Insured (Including Medicare With Part D & Medi-Cal Share of Cost)
Adult With Confidentiality Concerns
Adults with confidentiality concerns have insurance through a parent, spouse, or registered domestic partner, but are unable to use their insurance for PrEP due to confidentiality concerns.
Minor (12–17 years old)
- Temporary Coverage Client Attestation and Consent Form (English) (DocuSign)