Patient Forms
Save time during your appointment
Complete the requsted form prior to your visit. Simply print the needed form, fill in the requested information, and bring the completed form to your appointment.
Locations
Garden Grove
Tel: (714) 897-1071 | Fax: (714) 373-4696
Lakewood
Tel: (562) 925-7401 | Fax: ( 562) 925-8898
Downey
Tel: (562) 928-9700 | Fax: (562) 928 8300
Downtown Los Angeles
(Virtual visits only)
Tel: (213) 765-8123 | Fax: (213) 336-3032
Care Management
ECM California Helpline
Tel: (310) 280-5203
Washington Health Homes
Tel: (206) 926-3890

12566 Valley View Street
Garden Grove, CA 92845
Tel: (714) 897-1071
Member Resources
Report Fraud, Waste, and Abuse
Copyright © Titanium Healthcare® Inc. | All Rights Reserved.
Copyright © Titanium Healthcare® Inc.
All Rights Reserved.