Forms & Privacy Practices

Patient Forms

If you wish to have a copy of your medical records released to another party, please complete the Authorization Form below and bring it to our office: 

►Authorization for Disclosure of Protected Health Information

If You Are A New Patient, Please Print And Complete The Following Forms And Bring Them With You To Your First Visit:

►Pediatric Consent Form

►Adult Consent Form

Privacy Practices

If you wish to learn more about SRMC Primary Care - Salem’s privacy practices, including how your medical information may be used and disclosed and how you can get access to this information, Click Here to read our Notice of Privacy Practices.