All Forms

Below is a list of downloadable forms for our members’ convenience. Unless otherwise stated on the form, these forms must be mailed to:

Los Angeles Firemen’s Relief Association
P. O. Box 41903
Los Angeles, CA 90041

or faxed to (323) 259-5290 / DO NOT send any medical personal health information (PHI)

Add/Drop Dependent FAX to (323) 259-5297
Flu Vaccine Claim Form  FAX to (323) 259-5295
Unprocessed Medical Expenses Claim Form For CA Members (Green Form) FAX to (323) 259-5295

Relief Forms

Medical Forms

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