Your Shalom Patient Service Representative will advise you which forms are needed as part of your registration. Click on the below links to fill out the forms with basic information, you will then be redirected to a document with that information inserted and additional fields needing your input. You will then be asked to sign the document using e-signature. Your email address is required as part of the e-signature process.

Advance Directive

Patient Registration Form

Consent for Treatment of Minors and Release of Information

Patient Intake Forms

Shalom Health Care Center, Inc. receives federal funding from Department of Health and Human Services (HHS) and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.