Forms

If you would like to obtain a copy of your health records, please complete the attached form:

If you would like to request to have records sent to another facility/person, please complete the attached form:

If you would like to request a Change of Service Provider or a Second Opinion within the Placer County Adult System of Care, please complete the attached form:

If you would like to file a Grievance Appeal, please complete the attached form:

Complete the attached form to submit an Adult/Elder Abuse Confidential Report