Southern Family Medicine, LLC - Primary Care for York County, PA and Baltimore County, MD

PATIENT DOCUMENTS
SFM does NOT accept any completed documents electronically. After downloading the necessary documents below, please print them, complete them, and bring them to your appointment. Our new patient forms and policies are provided in Adobe PDF format. You must have Adobe Reader software to view them. If you don't have Adobe Reader, you can download it by clicking on the "Get Adobe Reader" button.
Click the links below to download our patient documents: Covid 19 Questionnaire Covid 19 Self-Isolation Handout Patient Information Form Patient History Questionnaire (Female) Patient History Questionnaire (Male) Patient History Questionnaire (Child) "Meaningful Use" Demographic Form Authorization to Release Medical Information ABN Combined Flu Highdose Flublok Reg Form and Questionnaire Patient Portal Authorization Form Notice of Privacy Practices Acknowledgement of Receipt of Notice of Privacy Practices Financial Policy Informed Consent for Telemedicine Services FMLA/Disability Form E-Mail Policy Authorization for Treatment of Minors Physical Exam & Office Visit Office Policies Agreement and Consent for Services If you need to transfer medical records from another health care provider, please complete this form: Authorization for Obtaining Health Information Copyright 2005 Southern Family Medicine, LLC ("SFM"). All rights in the documents provided on this web site are reserved by SFM. Except for use by SFM's patients in connection with health care services, no document provided on this web site may be reproduced, stored or transmitted in whole or in part, in any form or by any means without the prior written permission of SFM.

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Copyright 2004 Southern Family Medicine, LLC. All rights reserved. Use of this web site is subject to SFM's Terms of Service.
The SFM stethoscope logo is a registered service mark of Southern Family Medicine, LLC and may not be used without SFM's express prior written permission.
** This web site is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis or treatment. ** Always seek
the advice of a physician with any questions you have about a medical condition. If you believe you have a medical emergency, call 911 immediately.