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Smoky Hill Residency Program

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Forms/Documents

English

Authorization for Treatment of Minor Notary - Medical
Authorization for Treatment of Minor Notary - Dental
Financial Screening Application
Discount Program Guidelines
New Patient Acknowledgement & Consent Form
Notice of Privacy Practices
Patient Acknowledgement & Consent Form
Patient Registration Form
Patient Rights & Responsibilities

Spanish

Autorización para tratamiento del Menor Notario - Médico
Autorización para Tratamiento del Menor Notario – Dental
Aplicación para el Programa de Descuento
Nuevo Paciente forma de reconocimiento y consentimiento
Aviso de Practicas de Privacidad
Forma de reconocimiento y consentimiento
Forma de registro del paciente
Derechos y Responsabilidad del Paciente

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