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    ​(916) 454-2345

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one phone call away

(916) 454-2345

Forms

New Patients

Patients, particularly new patients, should click and review the forms listed below to determine if they are required to complete and submit prior to or at their first appointment (forms are in pdf format and can be printed out and completed by hand):

  • Patient Intake Packet (adult)

  • Patient Intake Packet (child)

  • Every Woman Counts

  • Dental Consent Form (adult)

  • Dental Consent Form (child)

Sliding Fee Discount Program

To help address financial barriers to accessing care for those who remain under- or uninsured, Elica offers a Sliding Fee Discount Program to those who qualify.

  • Sliding Fee Scale Brochure

  • Sliding Fee Scale Brochure (Spanish)

  • Sliding Fee Scale Brochure (Russian)

  • Application - English

  • Application - Russian

  • Application - Spanish

  • Application - Arabic

Staying Healthy

You can check out the staying healthy assessment by clicking on the link below!

view assessment

Volunteer

Volunteer applications and other related documents are available online, from the front desk at any of our eleven health center locations or mobile clinics. You can complete the application online and return it to us via email at workforcedevelopment@elicahealth.org.

To begin the process, please check our Volunteer page and fill out an application.

Information

Patients are seen by scheduled appointment, although some same day visits are reserved for walk-in patients who present with serious symptoms.

Keep your appointment as scheduled or if you are unable to make your scheduled appointment, please call (916) 454-2345 to notify us and reschedule your visit. If possible, a 24 hour advance notice is preferred.

Convenient 24-hour access to personal health information is now available through a secure, on-line patient portal website, which is linked above. Please call or ask a member of our health center staff about setting up your portal account.

Pathways Home + Health

A statewide pilot program for vulnerable Medi-Cal patients to improve health outcomes and reduce utilization of high-cost services.

  • Partner Organizations

  • FAQ

  • Community Listening Presentation

  • City Council Presentation

learn more

Additional Forms

  • Medical Record Release Form

  • Medical Record Release Form (Spanish)

  • Medical Record Release Form (Russian)

  • Patient Intake Packet (Spanish) [adult]

  • Patient Intake Packet (Spanish) [child]

  • Every Woman Counts (Spanish)

  • Dental Consent (Spanish) [adult]

  • Dental Consent (Spanish) [child]

  • Patient Intake Packet (Russian) [adult]

  • Patient Intake Packet (Russian) [child]

  • Every Woman Counts Application (Russian)

  • Dental Consent (Russian) [adult]

  • Dental Consent (Russian) [child]

Brochures

  • General Information Brochure

  • General Information Brochure (Spanish)

  • General Information Brochure (Russian)

  • New Patient Welcome Brochure

  • New Patient Welcome Brochure (Spanish)

  • New Patient Welcome Brochure (Russian)

  • Privacy Practices Information​​

  • Privacy Practices Information​​ (Spanish)

  • Privacy Practices Information​​ (Russian)

  • Patient Rights & Responsibilities

  • Patient Rights & Responsibilities (Spanish)

  • Patient Rights & Responsibilities (Russian)

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FQHC Award
NCQA award

Arden Arcade, Cadillac Dr, Franklin Blvd, Halyard Dr, Mack Road, Marysville Blvd, Midtown, Mobile Clinics, North Highlands, V Street, 15th St, Resource Center

(916) 454-2345

Support Our Cause

We strive to provide high quality, affordable health care for underserved populations, who are confronted with barriers to accessing care.

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