Attention Parents/Guardians:

Please fill out the form below, then you will be directed to a health history form and a consent form which can be signed electronically.








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.