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

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

954-998-3990

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

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