Registration & Forms
To register for and use our services, see the list of forms below.
John Muir Physician Network Forms
Authorization To Release Patient Health Information - Download PDF (66k)
Autorización Para El Uso O Divulgación de Información De Salud Protegida - Descargar PDF (68k)
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.
Confidential Communication Preference - Download PDF (47k)
Preferencia de Comunicación Confidencial - Descargar PDF (50k)
Use this form to tell us how you wish to be contacted for communication pertaining to confidential financial and/or medical information.
Financial Agreement - Download PDF (676k)
Acuerdo Financiero - Descargar PDF (80k)
Use this form to review the John Muir Health Financial Agreement. You may print the form, sign it, and bring it to your first office visit
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.
MyChart Family Access
Set Up Family Access
If you would like to set up access on MyChart 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.
Advance Health Care Directive - Download PDF (78k)
Directiva Por Anticipado de la Atencion de la Salud (78k)
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)
Solicitud de Asistencia para el Pago de Facturas (200k)
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.