How to Refer a Patient to FAP

Please follow the links below for the appropriate Referral Forms. Once the form is complete, please fax it to Francisca Guzman, FAP Project Coordinator: FAX # (650) 517-8973. To confirm receipt of fax please call (650) 517-8904.

Please make sure to get the patient’s signature on the referral form, or document the patient’s oral consent on the form.

Referral Form for patients at the San Mateo Medical Center Obstetrics Clinics

Referral Form

Referral Form for patients at Lucile Packard Children's Hospital or Ravenswood Family Health Center

Referral Form