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.
Mills-Peninsula assures protection of your personal health information.
Our website securely transfers your information to our data systems.
You can verify Mills-Peninsula is collecting your information over a
secure site by clicking on the padlock icon
located near your browser's address bar and viewing our certification form.
Mills-Peninsula provides financial assistance for low-income people who do not have health
insurance. For more information contact the Business Services Department at (650) 652-3000.