Patient Forms

All New Patients:
If you are a new patient coming into the clinic for the first time, print, complete and bring the New Patient Packet with you to your appointment.
New Patient Packet (PDF)

Tele-medicine Appointments:
Tele-health appointments can be utilized for General Medical, Psychiatry, Nutrition, and Behavioral Health.  Appointments require visual capabilities via web or telephone. Patients must download Microsoft Teams, schedule their appointment, and submit completed consent forms to
Consent for Tele-medicine appointment
Consent for Tele-psychiatry appointment
Consent for Tele-behavioral health appointment

Advanced Directive:
An advance directive is a written document in which people clearly specify how medical decisions affecting them are to be made if they are unable to make them, or to authorize a specific person to make such decisions for them. If you are interested in receiving a copy of an advanced directive, you may download it here or request one from the SHS front desk staff.
Advanced Directive (PDF)

Specialty Forms:
Print and complete these forms only if they are relevant to your appointment.
Medical Records Request / Release (PDF)
Authorization for Disclosure Health Information (PDF)
Parental Consent for Treatment of a Minor: General Care with Optional Consent for COVID-19 Testing, COVID-19 Vaccination
Alternate Parties Authorized to Consent for Medical Care for Minor
Parental Consent for Administration of Vaccines for a Minor
Parental Consent for Imaging of a Minor
Parental Consent for Serum Testing of a Minor