Privacy

We are an authorized Enrollment Entity for the State of California Healthy Families and Medi-Cal for Children and Expectant Mothers, (EE - 89481) We are not a State agency.

Privacy

We have the following policy regarding your privacy.

We make every effort to protect the privacy of our on-line visitors. We track the total number of visitors to our web site, but only gather personalized identification, such as address, e-mail address, etc. with visitor permission on our web site.

This information allows us to respond to your requests, and is used solely for internal purposes. Your personal information will never be sold or transferred to any third party at any time.
Our e-mail policy is simple: only those visitors that request e-mail responses will receive an e-mail response from us. You will not receive unsolicited e-mails from insurers, loan companies, or other firms because we do not share this information with third parties.

Our web site may contain links that allow you to visit other Web sites that are not under our control. As such, our web site is not responsible for the privacy practices, if any, of such linked Web sites. Please understand, as a consumer, you should be careful when you provide information about yourself or your family to Web sites on the Internet.

The Site expressly disclaims any and all liability for third party links on the Site and any claims of negligence arising from same.

Pre-Qualification Assessment

* Required Fields

Parent's Personal Information

First Name *	Middle Initial	Last Name *

Applicant Date of Birth		Email Address

Contact Information

Please ensure that you are entering the correct phone number. We will contact you using this number.

Home Address 1 *
Home Address 2
Home City *
Home State *
Home five-digit Zip Code *

Please enter your 10 digit phone number in this format : (123) 456-7890

Preferred Phone *	Phone 2	Phone 3
( ) -	( ) -	( ) -
Preferred time to call

Children

Number of Children Under 19 *:

Family Information

Language preference	Family monthly gross income (before tax)	Family size *
		(including yourself and an unborn child, if you have a pregnant mother at home)
Comments/Notifications