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New Member Packet
Physician Referral Form

 

For New Members

        We've tried to keep the signup process quick, simple, and easy as possible for you.  To the left is the link that displays, and can print, our entire New Member Packet in PDF format  (Acrobat Reader must be installed on your computer, a free program from Adobe).  Use your browser's Back Button to return to this page after you have printed the Packet.  Page 1 of this Packet contains the instructions.

    If desired, you may fill out the application directly as displayed on your computer's browser as follows:

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Click anywhere in the application, then press the Tab key, which will take you to the first yellow area (or field), and type in the information requested.

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Press your Tab key to advance to the next field, fill it out, and repeat until you come back to the first field.

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Once all the fields are filled out, print out the complete packet, and sign and date on page 4.

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Finally, mail or fax pages 2, 3, and 4 to us.

    If you have any questions, please phone us at (650)494-1300 or email us at ctf@cardiactherapy.org

    Upon receipt of your forms, we will promptly contact you.  We are looking forward to having you join us!

For New Members Interested in Expediting the Process

     Should you, as a prospective new member, want to expedite the sign-up process, please do the following:

  1. Complete the New Member Packet (the link is to the left above) either by completing in your browser then printing, or by printing then filling out in pen.

  2. Mail or fax the completed New Member Packet to us.

  3. Print out and take the Physician Referral Form (the link is to the left above, just below the New Member Packet) direct to your physician for his/her signature.

  4. After you have gotten your physician's signature on the Referral Form, please mail or fax it to us and we'll put the "pedal to the metal" and start the ball rolling immediately!

For Physicians

          Should you, a physician in our community, want to refer a patient of yours to us, use the link to the left that contains our Physician Referral Form in PDF format.  Please fill out the form, and then fax or mail it to us.  Thank you!