Forms & Policies

• Prep/Clear Liquid Diet Instructions
• Patients Guide to Surgery-Endo
• Notice of Privacy Practices
• Patient Rights and Responsibilities
• Sliding Fee Discount Application & Income Verification Form

Telemedicine Consent Form – Please review the following form. You may be requested to bring a signed copy before your first appointment.

• Informed Consent for Telemedicine Services
• Telehealth Access and User Guide

Advance Care Directive 

• ANTHC Advance Directive Conversation Guide
• ANTHC Advance Directive Brochure
• SEARHC Advance Directive Form

When completed, the following forms contain confidential information. We ask that, at this time, you do not email these forms to SEARHC. Also, we recommend patients avoid using public computers when providing personal health information.

• Authorization for Treatment with Telehealth Consent
• Notice of Privacy Practices Acknowledgement
• New Patient Registration Form

Visit the Health Records page to find and download the request forms.

• Behavioral Health Intake Packet
• Behavioral Health Client Handbook