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    Newborn Referral Form

    Welcome to the newborn referral form for the Palo Alto Medical Foundation Pediatrics and Family Medicine departments in Mountain View, Sunnyvale, Santa Clara and West Valley. If you’re expecting a baby, our form will help our staff find a doctor who is right for your family. We make it easy by helping you find a doctor for your child based on criteria that are important to you, like locations, gender, languages spoken and more. Choosing a doctor for your newborn is an important first step in ensuring your child’s life-long health.


    This page should be for non-urgent matters only and contain no personal medical information. The usual response time is between three to five business days.

    Referral Form

    • Please review your information carefully before pushing submit.
    • This form should NOT be used for medical advice and contain no personal medical information.

    Your Information

    Name*:

    Address:

    City, ST Zip:

    Phone:

    E-mail*:

    Preferred contact by*:

    mail phone e-mail

    Information to help us recommend a doctor for your child

    Are you currently pregnant?

    Yes No

    If yes, when is your due date:

    OB/GYN Doctor's Name

    Gender of Doctor

    female male no preference

    Type of Doctor

    Family Medicine (see patients of all ages)
    Pediatrician (see patients under 18)
    no preference

    Language Preference

    Which location do you prefer (please check all that apply):

    Mountain View Center
    701 E. El Camino Real
    Mountain View, CA 94040
    Sunnyvale Center
    201/401 Old San Francisco Road
    Sunnyvale, CA 94086
    Santa Clara Center
    2734 El Camino Real
    Santa Clara, CA 95051
    West Valley Center/Cupertino
    7225 Rainbow Drive
    San Jose, CA 95129

    Questions or Comments (no links or web code allowed):

    If you prefer, you can also call our referral hotline and leave a message 408- 523-3939 – our staff will respond to you within three to five business days.
    Additional Phone Numbers

    • Main Phone Numbers – 408-739-6000 or 650-934-7000
    • About a Bill -- 408-524-4100
    • Medical Records -- 650-934-7981
    • myCaminoMedical Support Line -- 408-523-3448

    For all other non-medical issues please contact:
    701 E. El Camino Real
    Mountain View, CA 94040
    650-934-7000 or 408-739-6000