Apply Now

Visit our portal page to begin your application today! It includes some easy to follow questions and the opportunity to submit your documents.

MedAssist Portal screenshot



Smiling woman in a meeting with another person

We've made all the necessary forms available for download on our website. We encourage you to review the forms carefully and fill them out completely to ensure a smooth and hassle-free application process.

If you have any questions or need assistance with the forms, don't hesitate to contact us – we're here to help!

Initial Application

A screenshot of the Initial application
Patient Application Packet








A screenshot of a W-9 form
A screenshot of ACH Registration form
ACH Registration
A screenshot of CA Form 590
CA Form 590
A screenshot of CA Form 587
CA Form 587







We're Here to Help You Every Step of the Way!

Don’t let some simple paperwork get in your way of getting money back. In person application assistance is available.

Reach out to us
Please call (408) 970-2001 to make an appointment. We are open Monday - Friday, 9:00am - 5:00pm.
Our office address is:
Santa Clara Valley Health
777 Turner Dr
San Jose, CA 95128


MedAssist logo

Learn More About MedAssist

Ready to learn more about how our money back program can benefit you? Dive deeper into the program by exploring our website and discovering all the ways we can help you earn cash back. Don't miss out on this opportunity to save money and protect your health.

A woman working on her laptop

How to Apply

Apply now and start enjoying the benefits of our money back program!

Apply Now

A mother and child smiling and rubbing noses


Got questions about MedAssist? Check out our FAQs for answers to some of the most commonly asked questions.

Get Answers

A smiling woman meeting with another person


We have all the necessary forms ready for you to print. Visit our forms page for everything you need.

Stay Organized

©2023 County of Santa Clara. All rights reserved.