School-Based Health

Additional Forms

Authorization to Release or Obtain Confidential Information
Affidavit for Consent for Health Care for a Minor
This form must be notarized. SCH has notaries available, for this purpose only, at our Tavern Road location from 8am-4pm daily.
Consent for Middle School Immunizations - NORTH
Consent for Elementary Immunizations - BURKE STREET, TUSCARORA AND OPEQUON

Insurance/Sliding Fee Discount Program

Shenandoah Valley Medical System, Inc. does business as Shenandoah Community Health (SCH). This health center receives Health and Human Services funding and has Federal Public Health Service deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. SCH is an equal opportunity provider, serving all patients regardless of ability to pay.

Shenandoah Community Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

School-Based Health

FAQ's

2022-2023 Enrollment Packet

Additional Forms

Notice of Privacy Practices

Insurance/Sliding Fee Discount Program