Skip to main content
San Francisco city sealSF.gov

Menu

  • Services
  • Departments
  • Jobs
  • Services
  • Departments
  • Jobs

English

  • Español
  • 繁體中文
  • Filipino
  • Tiếng Việt

INFO PAGE

Admission Forms

For instructions on completing and filing the forms below, contact the Laguna Honda Admission Office at 415-682-5683 or LHH.referral@sfdph.org.

Admission Application & House Rules

  • LHH Admission Application (English)
  • LHH Medicare Secondary Payer Form (English)
  • LHH Dental Clinic Form (English)
  • Laguna Honda Rules (English)
  • Laguna Honda Rules (Chinese)
  • Laguna Honda Rules (Spanish)
  • Laguna Honda Rules (Tagalog)
  • CDPH Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (English)
  • CDPH Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (Chinese)
  • CDPH Standard Admission Agreement for Skilled Nursing Facilities and Intermediate Care Facilities (Spanish)

Summary Notice of HIPAA Privacy Practices and Acknowledgement of Receipt

English | Chinese | Russian | Spanish | Tagalog | Vietnamese

Full Notice of HIPAA Privacy Rights

English | Chinese | Russian | Spanish | Tagalog | Vietnamese

Consent for Treatment

English | Chinese | Russian | Spanish | Tagalog | Vietnamese

Price Transparency: View Laguna Honda Hospital Pricing

Help Paying Your Bill

Departments

Department of Public Health

Related

Services Provided at Laguna Honda Hospital
Help Paying Your Bill – Laguna Honda Hospital
Laguna Honda Campus Tours
Was this page helpful?
Share your feedback
City of San Francisco seal and text reading 'City and County of San Francisco'

Our City

ServicesDepartmentsJobsContact us

Languages

EnglishEspañol繁體中文FilipinoTiếng Việt

Policy

Privacy policyDisclaimer
a poof of foga poof of fogthe sutro towerthe transamerica buildingthe salesforce tower buildinga poof of foga poof of fog