Request for Accommodation

In order for the board of directors to process your request in a timely manner, please provide the following information.


Name (Print)
Please provide us with the name and address of the doctor or healthcare provider, which will allow us to evaluate your request for accommodations or a detailed letter from that person on their letterhead. In providing this information you are granting the board and its managing agent to make contact with your provider.
Name of Doctor
City, State and Zip Code

Coast Management of California