SCHEDULE CLINIC TIME - Sandpoint Super Drug | Pharmacy | Ace Hardware

IMPORTANT: BEFORE YOU REQUEST APPOINTMENT

Please print the Patient Intake Form below, fill it out and bring it with you to your appointment.

SSD Clinical Intake Form

REQUEST AN APPOINTMENT

Please fill out the form below and send to us. We will contact you soon to confirm an appointment.

Your Name(Required)

First Last

Date of Birth

Your Address(Required)

Street Address Address Line 2 City State

Briefly describe your medical concerns

Your Email Address(Required)

Your Phone(Required)

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