Forms

General Forms & Health Information

In order to prepare for your upcoming visit, you may want to fill out some forms before you arrive.

• Advance Health Care Directive (Advanced Directive)
  English | Spanish
• Radiology Instructions

The Health Insurance Portability and Accountability Act (HIPAA) is a new set of federal rules designed to protect the privacy of individual health information.

To authorize Mills-Peninsula to disclose your health information, please fill out the following form and return it to us.

• Form for Disclosing Health Information

To request access to your health information, please fill out the following form and return it to us.

• Form for Accessing your Health Information

Mills-Peninsula Medical Center

1501 Trousdale Drive
Burlingame, CA

• Family Birth Center - Online Registration
• Pre-registration
• Surgery Center

Mills Health Center

100 S. San Mateo
San Mateo, CA

• Pre-registration
• Surgery Center

Please call (650) 696-5656 with any questions.