Admission Form

Before you fill out the admission form, please check with our Director of Christian Science Nursing that our facility has space for you. You can contact them at 510-886-2448 Ex 225 or dcsn@fernlodge.org.

If we have an opening, we will send you an admission form. Please download and print out the form before filling it out.

After filling out the form and signing it, there are three ways you may send it back to us:

  • You can scan and email the form to dcsn@fernlodge.org, with subject line "Admission Form"
  • You can mail the form to the following address:

    Fern Lodge
    18457 Madison Ave,
    Castro Valley, CA 94546
  • Or you can fax your form to (510) 886-5992.