Registration Forms

How to Register as an APLA Client

In order to become a registered client of AIDS Project Los Angeles, you will need to complete a Registration Packet, which includes the following forms:

• A Welcome Page with instructions for completing the Registration Packet, including how to provide Verification of Residence
• A list of documents used to provide Income Verification
• Financial Screening Form
• Registration Form (two pages)
• Physician Diagnosis Form
• Case Management Intake Form
• People with HIV/AIDS Bill of Rights and Responsibilities
  (two pages)
• Consent Form for Case Management Services
• Client Grievance Procedures Form
• Consent Form to Release Medical Information
• Service Planning Area (SPA) Map. This map divides Los Angeles into eight (8) sections, or SPAs. Depending on where you live and what services you want to use, you may need to find providers in the SPA where you live. We can help you figure this out.

You can register at APLA in four easy steps:

1. Print the Physician Diagnosis Form and give it to your doctor. Have him or her fill it out, sign and date it and return the original to you. Your physician can fax a copy of the form to: 213.201.1392.
2. Print the Registration Packet. Follow the instructions on the Welcome page. Fill out the form in its entirety, signing and dating where noted by an (X). Keep the original copies of this entire packet for yourself.
3. Bring your completed packet, including the original Physician Diagnosis Form, to APLA. You can walk in and hand-deliver your packet Monday through Friday from 9:00 am to 3:00 pm. You do not need an appointment to register as a client.
4. Your service provider or care giver can fax the completed Registration Packet to 213.201.1392 before you visit APLA. Please note: you will need to bring the original forms with you when you visit APLA.

Click here to download a Physician Diagnosis form. - PDF

Click here to download a Registration Packet. All forms and instructions are included in the packet, including the Physician Diagnosis Form. See the link above if you are looking for just this form. - PDF

Click here to request a Registration Packet by mail.

If you have questions about APLA, becoming a client or about any of the services we offer, call us at 213.201.1600 during normal business hours. We are happy to help.