CARE Act Stakeholder Feedback Form

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Thank you for your interest in the CARE Act Resource Center. The Department of Health Care Services (DHCS) and our training and technical assistance (TTA) partners at Health Management Associates are focused on supporting the seamless implementation of the CARE Act through ongoing TTA.

Please use this form to share your ideas, questions and concerns about CARE Act TTA. We value your expertise and experience.

Sharing your contact information is optional.

The TTA team will review all submissions and follow up within 5 business days. We will use feedback collected to inform our trainings, Frequently Asked Questions and stakeholder communications as appropriate.

Which county do you represent? *

What is your CARE Act role? Check all that apply. *

Administration/Management

Behavioral Health: Provider/Case Management

CARE Act Program team (DHCS, CalHHS, JCC, DVC, HMA)

CARE Act Working Group Member

Community Member

Counsel/Courts

Data Collection & Reporting

Finance

Housing/Community Supports

Policy/Advocacy

Volunteer Supporter

Other:

Required

Please share your ideas, questions or concerns. *

Optional Contact Information

What is your first name?

What is your last name?

What is your preferred pronoun?

She/Her/Hers

He/Him/His

They/Them/Theirs

Other:

Clear selection

What is your email address?

Please type your email address again to confirm.

Would you like someone from the TTA Team to follow up with you within 5 business days to discuss your feedback further?

Yes

Clear selection

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