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Patient forms and information (9)

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    Alternative access standards

    Learn more about alternative access standards for Medi-Cal members.

    Appeal and grievance form

    Use this form if you have an individual or family plan.

    Interpreting services

    Language assistance services are available to you at no cost.

    Medicare Shared Savings Program

    Learn more about the Optum California ACO and the high-quality care we offer Medicare patients.

    Member reimbursement claim form

    Please use this form to ask to be reimbursed for care you paid for.

    New patient form - California

    Download and fill out the personal information form.

    Patient rights and responsibilities

    This document explains your rights and responsibilities as an Optum patient.

    State consumer privacy notice

    Depending on which Optum product or service you use, and your state of residency, you may have rights as outlined in this Notice.

    Surprise billing protection

    Know your rights and protections against surprise billing.