Forms

For our patient’s convenience, we are providing you access to some of our forms right here online. That means that instead of filling these out in our waiting room, you can get them done ahead of time by printing them out at home. We hope to make your next appointment as efficient and painless as possible.

Federal Law requires all healthcare practices to obtain, verify, and record information to protect your identity.

Sumter Pediatrics, P.A. will require all parents, legal guardians, or authorized representatives of patients to submit a valid picture I.D. We will ask for your name, date of birth, and other information that will allow us to identify you.

New Patient Packet

Records Release form

Notice of Privacy Practice

Application for Employment