Patient Checklist

Being Seen In the Clinic? 
Remember to bring…

• Completed medical history form
• Current medication list form including dosage and frequency, including over-the-counter and herbal supplements
• Insurance card(s), co-pay and picture ID
• Copies of recent tests, imaging reports (x-rays, CAT Scans), past procedure reports or anything you want your provider to review during you’re appointment
• Arrive early; we are located in building “C” on the Salem Hospital campus. Allow plenty of time for parking and finding our clinic.