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Cleveland Regional Medical Hospital

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Carolinas Medical Center

eClinicWorks Portal

Please call our office to request an appointment as a new patient.

You may download and pre-fill out forms that need to be presented at the time of appointment.

Right click on the form icon or title to download a PDF that can be opened and printed with the free Adobe Acrobat Reader. Some Web browsers such as Google's Chrome can display and print these PDF files.

patient data

Shelby Medical Associates Patient Data Sheet

This form provides Shelby Medical Associates with all the pertinent information needed to provide proper care.

privacy practices

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

I got the privacy practices

Acknowledge Receipt of Privacy Practices

This form certifies that you have received the statement of Privacy Practices for Shelby Medical Associates..

Patient Financial Policy

This form contains valuable information regarding the financial responsibilities of patients of Shelby Medical Associates.

Medical Information Release

This form authorizes the release of your medical information to necessary parties in order to issue patients the best possible service..