Take this to your call or first visit
A printable from Mental Health Care. Fill it in by hand. Nothing you write is collected by this website.
Take this to your call or first visit
- My county line: San Mateo (800) 686-0101, or Santa Clara (800) 704-0900 then press 1
- Do I have Medi-Cal now? Full or restricted scope? When is my renewal due?
- What I want help with, in a few words
- The language I want to speak
- Is there a cost for me? Is there help to pay?
- What do you keep private, and when would you have to share?
- When is my first appointment, and what should I do while I wait?
- Name of the person I spoke with, and the date
In a crisis, call or text 988. If someone is in danger, call 911. Do not write your immigration status on this sheet.
From Mental Health Care. Facts checked October 21, 2026. Free information, not legal or medical advice.