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​​Client Application Forms

Client Application Forms by Client Type

Review the list of acceptable eligibility documents, or the list of acceptable eligibility documents for minors and clients with confidentiality concerns. The following lists contain forms that may be applicable to each client type, please note that not every form in the list will be required for each client.

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

  • Temporary Coverage Client Attestation and Consent Form (English) (DocuSign)

Immediate Access

Other Forms

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