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Pinner Clinic, PA

32 River Street

Peak, South Carolina 29122

(P) 803-945-7475
(P) 803-345-3298
(F) 803-945-0000

Providing patient-centered, quality, comprehensive care for all ages that is accessible and affordable, since 1915.

Patient Forms

Click on the links below to access patient forms. If you have any questions, or you can not find what you are looking for, please call our office at 803-945-7475. We are always happy to help!

New Patient
Paperwork

New patients

Make sure we have correct contact information on file

Compound Authorization for Release of Information

This form allows us to release your information to a family member or friend, as you designate

This agreement outlines our policies and expectations in regards to billing and payment for services you receive from us

Financial Policy

Patient Demographic Sheet

Notice of Privacy Practices

Receipt of Notice of Privacy Practices

Make sure we understand your past medical history and present health conditions

Help us understand other factors that may be affecting your health

Authorization for Release of Health Information

This form allows us to request your medical records from OTHER physicians

Patient Health Assessment

PCMH Questionnaire

Minor Consent Form

Permission to treat your minor child without your presence (i.e. a teenager coming in for a sports physical)

No Show Policy

We reserve the right to dismiss patients who fail to keep thier appointments

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