NEED TO GET CONNECTED TO COMMUNITY RESOURCES?

If you are in need of assistance, please complete the form below. You may also call our AVPH office at 661-942-4719.

Please Note:

Filling out this form means you are asking to be connected to a service provider in your area who is able to meet a social or medical need that you or someone in your care may have. Once completed, this form is sent to Antelope Valley Partners for Health (AVPH) who will process your request and assist you with accessing care or services. Someone from AVPH will contact you within 24 hours, Monday-Friday (or by the next working day if received during the weekend).
Please use this form only to request services for yourself, or a child (under 18 years old) or adult for whom you have legal guardianship. Consent submitted through this form should be signed by the person who would be receiving services, or by their parent or legal guardian only.

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