Appointments and Forms
Please use this link to self-schedule an appointment.
http://provider.kareo.com/dr-nora-gough-davis-1#?view=booking
The download below contains patient registration forms and other documents relating to your visit.
To ensure an efficient and enjoyable experience for all of our patients, we ask that you follow a few simple guidelines during your visit.
Walk-in patients are welcomed daily,however, this availability is subject to change depending on the number of walk-ins that have already been accepted during this time. For all other visits,
please make an appointment in advance by calling 662 754-3301 or sending us a message.
First-time visitors are required to fill out the new patient registration form, health questionare, are privacy form which can be downloaded and printed out in advance using the download link
below.
Thank you for your cooperation!
This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.
Shaw Family Medical Registration Form 12[...]
Microsoft Word document [20.5 KB]
This is our complete privacy policy as mandated in part by MS state law. For your convenience, you can download our full privacy notice.
SFM Privacy Notice.pdf
Adobe Acrobat document [372.3 KB]
This form is required to collect information about your health history. This information will be confidential.
Shaw Family Medical Health History 01091[...]
Microsoft Word document [33.9 KB]
This form is used for athletes participating in sports governed by the Mississippi High School Activities Association.
athletic_health_history.pdf
Adobe Acrobat document [82.6 KB]
This form is required for patients age 18 and under.
New Pt Pediatric.pdf
Adobe Acrobat document [2.3 MB]
This form is needed to provide covid results to school district.
Covid-19 Release of Records (1).docx
Microsoft Word document [14.7 KB]
Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.
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