forms & policies

This page holds the various patient forms Salem Pediatric Clinic uses - these are available for download in Adobe Acrobat format.

PDF Format

• New Patient Information & Forms Packet (includes):
• Acknowledgement and Consent Form
• Child Care Authorization Form
• Financial Policy Form
• New Patient History Form
• No Show Policy
• Patient Information Form
• Patient Privacy Notice
• SPC Phone System Menu
• Medical Records Release

• School Sports Pre-Participation Examination Form
• Genetic Research Consent Form
• Application for Employment