Using our Online Pre-Admission Form

Please enter your information on the following pages. The fields with an asterisk are required and must be completed in order for you to be able to submit the form; if these fields are left blank, your registration won't be sent.

Your Privacy

Alta Bates Summit Medical Center assures protection of your personal health information. Our website securely transfers your information to our data systems. You may read about our Privacy Policy and HIPAA requirements (Opens new window) here. You can verify Alta Bates Summit Medical Center is collecting your information over a secure site by clicking on the padlock icon located near your browser's address bar to view our certification form.

Financial Assistance

Alta Bates Summit Medical Center is a not-for-profit organization, and we recognize that medical bills are sometimes unexpected, and can be unaffordable. Because of this, Alta Bates Summit Medical Center has a financial assistance program also known as Charity Care. This program is designed to help patients that have no insurance, or limited insurance, with their bills. Financial Assistance is based on income, assets, and other factors. Confidentiality of information and individual dignity will be maintained for all that seek this service.

For specific information on our financial assistance program, please call our Financial Counseling staff at (510) 204-4197 for an information packet and application. Please be aware that we frequently approve Financial Assistance prior to providing services as well as after services are rendered.