Services

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 https://teams.microsoft.com/downloads, schedule their appointment, and submit completed consent forms to shsteleappt@usf.edu
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
Alternate Parties Authorized to Consent for Medical Care for Minor
Parental Consent for Serum/Blood Testing of Minor
Parental Consent for Imaging of a Minor
Parental Consent for Minors for Administration of Vaccines