Health history,
and Consent forms.
To
arrange a Health Mobile visit;
Please follow the instructions below.
The
process is simple and efficient, as we are anxious to bring our program to
you.
Contact Director of Patient Relations at Health Mobile, at (408) 879-0110 to
schedule a visit.
Download the Application Form and the Patient Medical History Form.
Photocopy and
distribute both forms to all interested
individuals.
Application and Consent Form ( English) (Spanish) (Korean)
Patient Medical History (
English) (Spanish) (Korean)
Fax the completed Application forms to:
Director of Patient
Relations Health Mobile at (408) 244-9553 or,
you can mail them to:
Health Mobile
1659 Scott Blvd. Suite 4,
Santa Clara, CA 95050.
Note: The Patient Medical History forms will be available at the Mobile and
can be completed by the patient before his or her appointment.
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