Silver Pine Patient Forms

Important information we need so we can start to be your health care provider.

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New Patient CPE Forms 15 +

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New Patient CPE Forms 0-14

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New Patient AWV Forms

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Complete Physical Exam

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New Patient Forms 15 +

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Annual Wellness Visit

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SPMG Financial Policy

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Notice Of Privacy Practices

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Patient Portal Instruction

Attention: As a patient of Silver Pine Medical Group we want you to know that we value your time and commitment to improving your health and well-being as well as the time and commitment of all our patients. Because of that, we make every effort to see you as close to your appointment time as possible. In return, we ask that you show the same consideration to our staff and fellow patients. We ask that if you are unable to keep your scheduled appointment that you call and provide notice no less than 24 hours before your appointment time. Failure to cancel no less than 24 hours before your appointment time or not showing for your scheduled appointment will result in a $25 charge. For all Complete Physical Exams (CPE’s) there will be a $50 charge for failing to cancel no less than 24 hours before your appointment time or not showing for your scheduled appointment.

FMLA, Disability, Insurance Forms and other Paperwork: Completion of these forms and paperwork is not a covered benefit under medical insurance plans. A fee will be charged for the completion of FMLA, Disability, Insurance or other paperwork.

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