top of page

South Central Primary Care Center Inc.

"Building a Healthy Community"

Family Medicine

Behavioral Health

Douglas, GA

Fitzgerald, GA

Ocilla, GA

Pearson, GA

Nashville, GA

Lenox, GA

Valdosta, GA

Patient Forms

Irwin County School Based Health Clinic

Ben Hill County School Based Health Clinic

COVID VACCINE/TEST PATIENT FORM

New Patient Form

Nuevas Formas De Patiente

Print and fill out appropriate form(s) to give to the office coordinator at your next appointment.

New Patient Pediatric Form

Nuevas Forma Pediátrica

Patient Information Short Packet

Pediatric Information Short Packet

Sliding Scale Application

Aplicacion de Sliding Scale Fee

Patient Rights and Responsibilities

Derechos y responsabilidades del paciente

Televisit Consent Form

Release of Information

Release of Information for Use or Disclosure of Protected Health Information

Behavioral Health Consent Form

Forma de Consentimiento Para Salud Mental

No Suprise Act

bottom of page