Change of Provider Request

Print
Press Enter to show all options, press Tab go to next option

We try to do our best in working with both consumers and providers, but we understand that sometimes things do not work out as planned. If you are not satisfied with your mental health service provider and would like to change providers, please fill out the Change of Provider form in your preferred language. When you are finished, please mail the form to:

Fresno County Mental Health Plan
P.O. Box 45003
Fresno, California 93718-9886

If you would like to speak with someone about this request, please call: 1-800-654-3937.

If you use TTY, call the California Relay Service by dialing 711.

Thank you for taking the time to notify us.

Free viewers are required for some of the attached documents.
They can be downloaded by clicking on the icons below.

Acrobat Reader Flash Player Windows Media Player Microsoft Silverlight Word Viewer Excel Viewer PowerPoint Viewer