Schedule a Housecall
We bring premium care to you
Register for a Housecall Appointment
Welcome. This practice is constructed around elders and their families. Our differences are explained below. In addition, we are required to have you acknowledge notification of several items. Please follow these 4 easy steps.
Step 1
Contact Us
Step 2
fill out secure online enrollment form*
*Also available as download.
IMPORTANT: The form does not ‘save’ and will ‘time out’ so please have all information at hand prior to submitting.
Step 3
fill out our 5 required forms
Once the appointment has been set up, there are 6 forms (below) we need signed before we can begin working with your family. For your convenience you can securely sign up online and if you have any questions please call 650-357-8834 x1.
Coverage Levels
This form indicates various coverage plans offered.
Services Agreement
This form details the various services we provide.
Notice of Privacy Practices
This notice describes our use of your medical information.
Authorization to Release Medical Information
This notice describes our use of your medical information.
Medicare Opt Out Contract
This notice confirms confirms you understand our Medicare Opt Out status.
Fees and Services
This form indicates various services offered with associated fee.
Step 4
COMPLETE PROCESS
Fax signed documents to 650-357-8811. After documents are faxed, call 650-357-8834 x1 to complete the registration process.