Campbell County Memorial Hospital
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Forms

Please complete and print the forms below, and bring with you on your visit.

Adult Intake Form

Child Intake Form

The Release of Information Form (in the Adult/Child Intake Forms) must be completed in its entirety before any medical records can be released. The patient's signature and a copy of their photo ID is also required, along with a witness signature. (It can be anybody over the age of 18).

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