Request More Information/ Referral Form

Use this form to contact us to get more information about our
company, products, or services.
OR Refer someone!
My Information (Person Who is Referring)
Your name:
Your email address:
Your phone number:
Their Information (Person Who you are Referring)
Referral name:
Referral email address:
Referral phone number:
Optional Patient Info - Not required, but helpful
Date of Birth/Age:
Medi-Cal Managed
Care Insurance
Medical Condiitons:
Contact Information

Location: 340 Rancheros Drive Suite 196 San
Marcos, CA 92069

(We are located in the Heart of North San
Diego County,next to the San Marcos
Community Health Center)

Phone: (760) 682-2424

Fax:  (760) 471-5104

Hours of Operation

Office Hours: Monday-Friday 8:00 AM to 4:30

Center Hours: Monday-Friday 8:00 AM to
4:00 PM
Contact Us
Copyright 2008 AmeriCare ADHC All rights reserved.
Call Us (760) 682-2424