Patient Forms

Additional Forms

Consent for Healthcare for a Minor
This form must be notarized. SCH has notaries available, for this purpse only, at our Tavern Road location from 8am-4pm daily.

Authorization to Release Confidential Information

Sliding Fee

Brochure
Application

Shenandoah Valley Medical System, Inc. does business as Shenandoah Community Health (SCH). This health center receives Health and Human Services funding and has Federal Public Health Service deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. SCH is an equal opportunity provider, serving all patients regardless of ability to pay.

Shenandoah Community Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Patient Forms

Primary Care – Adult and Pediatrics

Women’s Health

Behavioral Health

Oral Health

Additional Forms

Sliding Fee