SALEM PEDIATRIC CLINIC

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

Microsoft Word format
New Patient Information & Forms Packet (includes):
        Acknowledgement and Consent Form
        Child Care Authorization Form
        Financial Policy
        New Patient History Form
        No Show Policy
        Patient Information Form
        Patient Privacy Notice
        SPC Phone System Menu
       Protected Health Information Authorization Form

Adobe Acrobat 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
        Protected Health Information Authorization Form