Medi-Cal Oral Health Information Form
Please check the answers that apply to you. Complete one form for each person in your family who is enrolled in Health Net. If you have questions, please call Health Net toll-free at 1-833-493-0428. A representative is available to speak with you Monday through Friday, between 8:00 am and 5:00 pm. TDD/TTY users should dial 1-800-466-7566.