Patient Forms/Documents


 
Click on any form below to download a printable PDF file of that form. Please complete and bring these forms with you to your appointment. Thank you.
 
The forms listed below are available for download in Adobe PDF format. If you haven't installed Acrobat® Reader® on your computer, in order to view and print these forms, please download and install the
Acrobat Reader from the Adobe website.
 
Patient Forms

Miscellaneous Forms

  • State Disability

    • Use this link to go to the Employment Development Department (EDD) home page to look for disability forms and other related information.

  • Application for Disabled Person Placard or Plates

    • Use this link to go to the California Department of Motor Vehicles website to apply for a handicapped placard or license plates.
       

20555 Prospect Rd
Cupertino, CA 95014

408-996-9339

Monday 9:00 am - 5:00 pm

Tuesday 9:00 am - 5:00 pm

Wednesday 9:00 am - 5:00 pm

Thursday 9:00 am - 5:00 pm

Friday 9:00 am - 5:00 pm

Closed for lunch between 12:00noon - 2:00pm
After hours you may speak with an advice nurse at
(888) 472-2472

Have a question? Go to our FAQ page or call us at 408-996-9339.

© 2018 Blue Hills Medical Group