Provider Documents

If you are a provider including teacher, social worker, or care giver, please fill out the referral form.

If your patient has CalOptima or Healthy Families through CalOptima, they require that you fill out a request form to CalOptima's Childhood Obesity Prevention and Treatment Program (COPTP) and fax it in to CalOptima's Health Education. The contact information for the PCP's to fax the request form back to CalOptima is also on the request form.

If you have any other insurance (or no insurance), please fill out the general referral form.

We look forward to the opportunity to collaborate.

Referral Form with Locations and Insurances

COPTP Referral Form combined with CalOptima