Mills-Peninsula Hospital, Burlingame, CA 94010
Your First Appointment
Please arrive early so that we can complete your initial paperwork. Also, please bring the following:
- Patient's insurance card
- List of current prescriptions and/or over-the-counter medication, including dose and frequency
- Information about patient's medical and surgical history
- Recent test results, x-rays, or relevant records
- Patient History Form [PDF]
- Review of Systems Form [PDF]
- Financial Information Form [PDF]
- Financial Policy Form [PDF]
- Surgery Registration [PDF]
- Pre-Anesthesia Evaluation [PDF]
- Surgery Guide for Patients [PDF]
- Ethnicity Race Form [PDF]
- Medical Release Form [PDF]
Insurance and Payment Information
Mid-Peninsula Urology Group is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.
Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.
A copy of our Notice of Privacy Practices will soon be posted on this website.