Lead Card Information | Clinicas

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Lead Card Information

Lead Card Information

Lead Card Information

Please Contact Me.

Name:

Date of Birth:

Address:

City:

State:

Zip:

Phone:

Date:

I have a Medicare only
I have a Medicare & Medi-Cal
I received Part D Extra Help

Preferred language:

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Spanish

What is the best time to reach you: A sales person may call as a result of returning this card.
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For questions please call: 1-800-509-1440
Clinicas del Camino Real, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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Clinicas del Camino Real, Inc. health centers are Federal Torts Claims Act (FTCA) deemed facilities. This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. This website is for information and educational use only. It should not be construed as medical advice or instruction. If you need medical advice, see your healthcare provider.

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