Forms

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

Federal Law requires all healthcare practices obtain, verify, and record information in order 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.

Sumter Pediatrics Patient Information Form

Records Release form

Notice of Privacy Practice

 

 

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