Patient Forms

Welcome to MemorialCare Medical Group. For your convenience, please print and fill out all applicable forms and present them to the front desk when you arrive for your first office visit.




myChart Proxy Access

Advance Health Care Directive

MemorialCare Medical Group/MemorialCare recommend completing an Advance Directive/Medical Power of Attorney/Living Will/Physician Order for Life-Sustaining Treatment (POLST) form on file in your medical record. See Palliative Care & Planning for more information.

Use these forms to obtain your records from MemorialCare, or to have them sent to MemorialCare from another health provider.

Use this form to opt-out of the MemorialCare Health Information Exchange

If you have any questions or you need more information, please contact our Medical Records Department at (714) 665-1647 or by FAX at (714) 665-1644.