Please completely fill in ALL areas to include the following: • Patient Information: Patient Name, Patient Date of Birth and Phone. Number. Most Court documents are provided as PDF files.To view or print these files you need the free Adobe Acrobat Reader or other PDF reader. The Alliance Prior Authorization (PA) Request Form is used for all services requiring prior authorization from the Alliance. Print and complete the Alameda County Behavioral Authorization to Disclosure Psychotherapy Notes form: English (PDF). Blank Application Forms. The below forms may be dropped at a secure drop box, at one of our offices, during regular business hours, am to pm. Contact Us: City Hall Address: 2263 Santa Clara Avenue Alameda, CA 94501 (510) 747-7400

Authorization Letter With Documents In Alameda

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