Newborn Referral Form

Welcome to the newborn referral form for the Palo Alto Medical Foundation Pediatrics and Family Medicine departments in Mountain View, Sunnyvale, Santa Clara and West Valley. If you’re expecting a baby, our form will help our staff find a doctor who is right for your family. We make it easy by helping you find a doctor for your child based on criteria that are important to you, like locations, gender, languages spoken and more. Choosing a doctor for your newborn is an important first step in ensuring your child’s life-long health.


This page should be for non-urgent matters only and contain no personal medical information. The usual response time is between three to five business days.

Referral Form

  • Please review your information carefully before pushing submit.
  • This form should NOT be used for medical advice and contain no personal medical information.

Your Information

Name*:

Address:

City, ST Zip:

Phone:

E-mail*:

Preferred contact by*:

mail phone e-mail

Information to help us recommend a doctor for your child

Are you currently pregnant?

Yes No

If yes, when is your due date:

OB/GYN Doctor's Name

Gender of Doctor

female male no preference

Type of Doctor

Family Medicine (see patients of all ages)
Pediatrician (see patients under 18)
no preference

Language Preference

Which location do you prefer (please check all that apply):

Mountain View Center
701 E. El Camino Real
Mountain View, CA 94040
Sunnyvale Center
201/401 Old San Francisco Road
Sunnyvale, CA 94086
Santa Clara Center
2734 El Camino Real
Santa Clara, CA 95051
West Valley Center/Cupertino
7225 Rainbow Drive
San Jose, CA 95129

Questions or Comments (no links or web code allowed):

If you prefer, you can also call our referral hotline and leave a message 408- 523-3939 – our staff will respond to you within three to five business days.
Additional Phone Numbers

  • Main Phone Numbers – 408-739-6000 or 650-934-7000
  • About a Bill -- 408-524-4100
  • Medical Records -- 650-934-7981
  • myCaminoMedical Support Line -- 408-523-3448

For all other non-medical issues please contact:
701 E. El Camino Real
Mountain View, CA 94040
650-934-7000 or 408-739-6000