Preventative Care Form

This page is for patients seeking preventive care services. Choose one of the options below to submit your form.

1) Complete the online form below (takes about 15–30 minutes).
Please don’t refresh or leave the page while filling it out.

Or

2) Download the PDF, fill it out (digitally or by hand), then drop it off at SSMC (Entrance G1) on RRH.org/map or email it to SSMC@RRH.org.
Preventive Care PDF Download