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CPHS Forms

Complete forms online or download a PDF to print. 

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Contact us if you have any questions.

Consent to Treat

Online  /  PDF

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Chronic Care Management Patient Consent Form

Online  /  PDF

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Adult Patient History

PDF

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HIPAA Notice of Privacy Practices & Policies

Online  /  PDF

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CPHS Policies

Online  /  PDF

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© 2024 Carolina Personalized Health Solutions

CONTACT US

Serving SC in York, Lancaster, Chester, and Chesterfield counties.

 

Call or email us to make an appointment.

 

info@cphs.care

T:  803-784-4429

F:  803-262-0198

Square

Scan the QR code below with your phone, or click here to pay with Square. Include Patient Name or Invoice Number.

PAYMENTS

Venmo

Scan the QR code below with your phone, or in the Venmo app pay Shere-CPHS.

Include Patient Name or Invoice Number.

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