Forms

Click to view or download the forms below.

• Consent to Share Information (HIPAA Release) View | Download
• Patient’s Financial Policy View | Download
• Patient Registration Form View | Download
• Authorization to Release Medical Records to CBS division of SHWHC View | Download
• Authorization to Release Medical Records from CBS division of SHWHC View | Download
• Notice of Privacy Practices View | Download
• Patient Request for Access to Health Record View | Download

“Dr. Runk coming into my life and taking care of me was meant to be. She’s definitely the reason that I’m still here with my family today.”

— Kelly R.