Home
About Us
Services
Insurances
Direct Primary Care
New Patient Forms
Contact Us
Medical News
More

Home
About Us
Services
Insurances
Direct Primary Care
New Patient Forms
Contact Us
Medical News

Salei Primary Care

Salei Primary CareSalei Primary CareSalei Primary Care

Providing you with individualized primary care.

Providing you with individualized primary care.Providing you with individualized primary care.Providing you with individualized primary care.Providing you with individualized primary care.

Downloads

Please download and fill out the following forms prior to your visit.

Forms can be printed and handed in at your appointment, or emailed to saleiprimarycare@gmail.com.

New Patient Registration (pdf)Download

Pediatric New Patient Registration (pdf)Download

Authorization for the Release of Medical Records (pdf)Download

Patient Consent for Use and Disclosure of Protected Health Information (pdf)Download

Patient Authorization for Use and Disclosure of Protected Health Information (pdf)Download

Patient Responsibility Form (pdf)Download

Informed Consent for Telemedicine Services (pdf)Download

Notice Of Privacy Practices (for your records, no signature required) (pdf)Download

How Did You Hear About Us? (pdf)Download

Salei Primary Care Inc

2100 E Hallandale Beach Blvd Suite 302, Hallandale Beach, FL 33009

Copyright © 2021 Salei Primary Care Inc - All Rights Reserved.

Powered by GoDaddy