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California Children Services:
CCS
The following
form is for referring children to California Children Services,
a program offering services to children with special health care
needs. To determine if this is a program that could be beneficial
to you, please view the description of the services by clicking
California Children Services. For persons
making a referral to CCS, please be complete. Without your information,
we may not be able to contact a family. Please discuss the referral
with the family.
Download
the CCS Referral/Request Form in Adobe Acrobat format.
To obtain
the California Department of Health Services's Application to Determine
CCS Program Eligibility (DHS4480). Please
click here to link to the DHS Forms and Publications page.
You may download
and complete this form on your computer. You may return it to CCS
by FAX (805 681-4763) OR by mail. Call CCS to verify the receipt
of this form.
Send to:
California Children Services
1111 Chapala Street, Suite 200
Santa Barbara, CA 93101
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