logo
logo

Patient Forms

To download forms, click the links below. Please print and fill out these forms. Once complete, please email them to us at Christy.Sullivan@shcr.com or mail them to our Clearwater Office before your first appointment.

Patient History

Policy Acknowledgement

Opioid Acknowledgement

You may need to install Adobe Reader in order to view these forms. Get Adobe Reader

Clearwater Office

430 Morton Plant Street, Suite 210
Clearwater, FL 33756

Ph: (727) 446-4506
Fax: (727) 446-4695

HOURS
Monday – Friday 8:30 am – 4:30 pm
(closed for lunch from 12:00pm – 1:00pm)

Pinellas Park Office

7800 66th Street North, Suite 202
Pinellas Park, FL 33781

Ph: (727) 431-7737
Fax: (727) 431-3718

HOURS
Tuesday, Wednesday and Friday 8:30 am – 4:30 pm
(closed for lunch from 12:00pm – 1:00pm)

Hospital Affiliations

MORTON PLANT HOSPITAL
300 Pinellas Street
Clearwater, FL 33756
Ph: (727) 462-7000

WEST BAY SURGERY CENTER
1401 West Bay Drive
Largo, FL 33770
727-585-9500

ORTHOPAEDIC SURGERY CENTER OF CLEARWATER
402 Jeffords Street
Clearwater, FL 33756
727-448-0822

Contact

CLEARWATER OFFICE
(727) 446-4506

PINELLAS PARK OFFICE
(727) 873-3988