PACE

Common Forms

Authorizations, requests and more

Appeal for Reconsideration of Denial Download PDF Icon Use this PACE form, to appeal a denial

Authorization for Release of Protected Health Download PDF Icon Use this form to authorize CalOptima to release your protected health information (PHI) to another person or organization. See next item below, on how to complete this form.

Grievance Form Download PDF Icon Use this PACE form to file a grievance.

Individual Request for Protected Health Information (PHI) Access Download PDF Icon CalOptima members, past and current, can use this form to request copies of their protected health information (PHI).

PACE Referral Form Download PDF Icon Use this form to refer someone to PACE.

Suspected Fraud or Abuse Referral Form Download PDF Icon Use this form to report suspected fraud or abuse. You do not have to give your name to report suspected fraud or abuse.

Contact Us
  • PACE Customer Service
    You can contact us Monday through Friday from 8 a.m. to 4:30 p.m.
    1-714-468-1100 Local
    1-855-785-2584 Toll-free
    1-714-468-1063 TDD/TTY

  • Sign Up for PACE
    1-714-468-1100 Local
    Enrollment information
Visit Us
  • Visit our office Monday through Friday from 8 a.m. to 4:30 p.m.
    Walk-ins welcome.
    We are closed on certain holidays.
    Map and directions
    13300 Garden Grove Blvd.
    Garden Grove, CA 92843

  • We speak your language
    Request interpreter services
New PACE Members
Forms and Documents

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