Registration & Forms

Registration & Forms

You may need to make a simple office visit or schedule a complex surgery. Whatever the reason for your visit, we need to know a little bit about you to ensure you get the care you're looking for.

To register for and use our services, see the list of forms below.

Primary Care Forms

Authorization To Release Patient Health Information - Download PDF (1MB)

Use this form to authorize the use of, or disclose information related to your Health Records and Health Information, Status of Claims, Enrollment and Eligibility Inquiries, and Status of Authorizations.

Pre-register for Services

Pre-register Online for Surgeries, Procedures, Tests, and Births
Use this online registration form for scheduled surgeries, tests, and procedures, radiology (ultrasound, computed tomography, magnetic resonance imaging, x-rays), mammography, cardiac tests (angiography, EKG), endoscopy, digestive tract and eye procedures, lab work, and births.

Outpatient Rehabilitation Registration Forms

Outpatient Rehabilitation General Form for New Patients - Download PDF (372k)
Useful information for patients who are getting treatment at one of John Muir Health's outpatient rehabilitation clinics and who have conditions or injuries related to most body parts, including the spine, leg, or shoulder.

Outpatient Rehabilitation Hand Therapy Form for New Patients - Download PDF (372k)
Useful information for patients who are getting treatment at one of John Muir Health's outpatient rehabilitation clinics and who have disorders or injuries related to the elbow, wrist, hand, or fingers.

Outpatient Rehabilitation Neurological Conditions Form for New Patients - Download PDF 282k
Useful information for patients with neurological disorders who are getting treatment at one of John Muir Health's outpatient rehabilitation clinics, including those who have had a stroke, Parkinson's disease, or multiple sclerosis.

Outpatient Pediatric Registration Packet for New Patients PDF (686k)
A useful packet of information for pediatric patients with conditions related to most body parts including the spine, legs, and shoulders.

MyJohnMuirHealth Family Access

Set Up Family Access
If you would like to set up access on MyJohnMuirHealth to manage the health of others online, for whom you have the legal right to do so, please use the link above to find and complete the form that is right for your situation.

Other Forms

Advance Directive - Download PDF (224k)
A legal document that allows patients to make treatment preferences known and designate a surrogate to make medical decisions should they become unable to make them on their own. Advance directives include living wills, powers of attorney, and health care proxies.

Patient Financial Assistance Application - Download PDF (62k)
Use this form to apply for financial assistance from John Muir Health. While you must meet certain financial criteria to be eligible, we know that quality medical care is expensive and want to help those who need it.

Post Anesthesia Care Unit Handout - Download PDF (678k)
Useful information for families/significant others with a loved one in the post anesthesia care unit.