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Patient Policies & Forms

Thank you for making SEARHC your health care provider of choice. We appreciate the trust you place in us to take care of you and your loved ones. Our high-quality care extends beyond clinical care to our business services as well. Please find more information about specific patient policies below:

Patient Policy Forms

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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

Your Advance Care

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Advance Care Directive 

Health Records Request

Click Health Records Request for additional information.

Telehealth Information

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

Registration

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.

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Authorization for Treatment and Promise to Pay with Telehealth Consent (fillable form)

Notice of Privacy Practices Acknowledgement (fillable form)

New Patient Registration Form (fillable form)

Bondholder Documents

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Bondholder documents