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 (Pediatrics) 2652 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