Forms

Parent/Guardian Forms

Parental Consent for Treatment and Care of Minors

Required for patients under the age of 18

 

Patient Forms

Authorization for Use or Disclosure of Protected Health Information

To have your medical records sent to FAU or released by FAU, please complete this form and allow up to 2 weeks for processing.

Mantra Health

If SHS has referred you to Mantra Health, please complete this form.

Designation of a Health Care Surrogate

If you wish to designate a health care surrogate", please print and complete this form..

 

Feedback and Complaints

Feedback and Complaints

You may use the Feedback and Complaints form for:

• Compliments
• Suggestions
• Reporting a Negative Experience at SHS
• Requestin Corrective Actions from SHS