Get your 2016-2017 Flu Vaccine!!
Get your 2016-2017 Flu Vaccine!!
SHAW FAMILY MEDICAL New Office Hours at the Shaw location Starting September 5, 2017!!! Monday-Friday 8:00AM-9:00PM (Closed Weekends and Holidays) See our Virtual Clinic services
              SHAW FAMILY MEDICALNew Office Hours at the Shaw location Starting September 5, 2017!!!Monday-Friday 8:00AM-9:00PM (Closed Weekends and Holidays)See our Virtual Clinic services

Appointments and Forms

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!

New Adult Patient Regiatration/Consent Form
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 01[...]
Microsoft Word document [21.6 KB]
Adult Health History (Required for New Adult Patients)
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]
Children's Consent and Health History
This form is required for patients age 18 and under.
New Pt Pediatric.pdf
Adobe Acrobat document [2.3 MB]
Privacy Notice (Required for All New Patients)
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]
Athletic Participation Form (Sports Physical Form)
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]

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

Where to Find Us:

SHAW FAMILY MEDICAL
112 W Peeler Ave
Shaw, MS 38773
Phone: (662) 754-3301

GOUGH'S FAMILY MEDICAL CLINIC

189 N Main Street

Drew, MS 38737

Phone: (662)745-6638

Office Hours

Shaw Family Medical 

Mon - Fri

8:00AM-9:00PM

Gough's Family Medical Clinic

Mon, Tues, Thur

8:00AM-5:00 PM

Wed, Fri

8:00AM-12:00PM

Virtual Clinic

7 Days Per Week

8:00AM until 12:00 Midnight

Practice News

Get the latest news from our practice right here on our website.

Print Print | Sitemap
© SHAW FAMILY MEDICAL