Download a Healthy Families Application

Download the Application Package or the Application Form

These items are in Acrobat pdf format, and you will need Acrobat Reader to see them. Click on the icon at left to download a free copy of Adobe Acrobat Reader if you do not have the program.

Form only

If you do not need specific instructions, you can download the Application Form without Instructions. This black and white version will take less time to download and print.


	Application Form without Instructions (English) 183 KB
	Application Form without Instructions (Spanish) 190 KB
	Application Form without Instructions (Arabic) 201 KB
	Application Form without Instructions (Armenian) 97 KB
	Application Form without Instructions (Chinese) 467 KB
	Application Form without Instructions (Farsi) 112 KB
	Application Form without Instructions (Hmong) 183 KB
	Application Form without Instructions (Khmer/Cambodian) 238 KB
	Application Form without Instructions (Korean) 283 KB
	Application Form without Instructions (Russian) 184 KB
	Application Form without Instructions (Tagalog) 184 KB
	Application Form without Instructions (Vietnamese) 228 KB

Last updated 04/2008

Federal Income Guidelines

Use the Federal Income Guidelines chart to help determine a person's possible eligibility for Healthy Families or Medi-Cal.


	Federal Income Guidelines 3,145 KB

Last updated 04/2008

The Application Package is a complete, 12-page, full-color version of the Healthy Families application. This Application Package includes the application form and specific instructions on how to fill out the application. Due to its large file size, the Application Package may take several minutes to download and print.