You may download and print forms or you may request forms to be mailed to you.
Your answers to the health equity questionnaire will help us record your cultural and linguistic needs, share those preferences with your providers, develop more inclusive programs and services, educate our workforce, and more respectfully engage with the people and communities we serve.
As a reminder, your privacy is important to us. This optional, secure questionnaire and the information you provide will be protected through our established and tested privacy and digital security policies. This information will not be used to make any decisions about coverage or services. Come back anytime to make updates.
If you have any questions or need help with language assistance, please call the number on the back of your ID card.
Note, if you have dependents who are under the age of 18 or you are a CHIP parent or guardian, you may complete the questionnaire on their behalf.