Forms & Documents

For Your Convenience

Prior to your hospital, clinic or telehealth visit, you may be asked to review or fill out forms. For your convenience, the forms are available to read or for download below.

Conditions of Admission: English  Spanish

Conditions of Service: English  Spanish

Genetic Information and Research Informed Consent and Right to Decline:  English  Spanish

Important Message From Medicare: English  Spanish

Medicare Outpatient Observation Notice: English  Spanish

Notice of Privacy Practices: English  Spanish

MyChart Video Visit Instructions

Have you scheduled a video appointment with your Samaritan health care provider? Click the button for helpful instructions on how to get  prepared on your computer or smartphone. 

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