Digital Forms For Your Convenience
Save time when visiting the office by downloading all your patient forms here, or submit your forms online for an easy, paper-free experience.
Patient Intake Form
We’d like to welcome you as a new patient. Please take the time to fill out this form as accurately as possible so we can most appropriately address your health needs.
Mental Health Intake Form
We’d like to welcome you as a new patient. Please take the time to fill out this form as accurately as possible so we can most appropriately address your health needs.
HIPPA Acknowledgement Form
We at Truesdale Medical Center are required by law to maintain the privacy of and provide individuals with the attached Notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to the Notice, please ask to speak with our HIPAA Compliance Officer in person or by phone at 843-747-2273. A copy of the Notice is available upon request.
Medical Release Authorization Form
The Medical Release Authorization Form is used to request that a Truesdale Medical Center release a patient’s medical records, either to the patient, a third party (such as an employer or insurance company), or both.
Financial Policy Form
We are committed to meeting your healthcare needs. Our goal is to keep your insurance or other financial arrangements as simple as possible. In order to accomplish this in a cost effective manner, we please review and return the financial policy document.
General Consent and Disclosure Form
The information in this consent form is given so that you will be better informed about the health care services you will receive. After you are sure you understand the information which will be given about the services and if you agree to receive the services, you must sign this form to indicate that you understand and consent to the services.