Using our Online Pre-Admission Form

Please enter your information on the following pages. This form should take 10-15 minutes to complete. You will need your insurance information. 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

California Pacific 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). You can verify California Pacific 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

California Pacific Medical Center is a not-for-profit organization. We recognize that medical bills are sometimes unexpected and can be unaffordable. Because of this, California Pacific Medical Center has a financial assistance program known as Charity Care. This program is designed to help patients who 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 who seek this service.

For specific information on our financial assistance program, please call our Financial Counselor Supervisor at (415) 641-6463 or e-mail thomassk@sutterhealth.org for an information packet and application. Please be aware that financial assistance eligibility is often determined after services are rendered, and the hospital deposit requirements have been met. To inquire about the status of your application, please call our Customer Service at (415) 600-7289.