Southeastern Healthcare Info

Southeastern Healthcare Information
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Downloadable Forms

Under Section 2799B-6 of the Public Health Service Act, health care providers and health care facilities
are required to provide a good faith estimate of expected charges for items and services to individuals
who are not enrolled in a plan or coverage or a Federal health care program, or not seeking to file a
claim with their plan or coverage both orally and in writing, upon request or at the time of scheduling
health care items and services.
Medical Forms below can be printed and filled out to bring in on your visit:
       
       

Medical Forms below can be printed and filled out to bring in on your visit:

Insurance and Cash Patients forms
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