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VISITOR SBHC Enrollment Form

To properly submit the form:

  1. Download the pdf to your computer.
  2. Fill out the form completely.
  3. Hit the submit button when you have completed the form and follow the on screen directions.

pdf SBHC-Enrollment-Form.pdf

Hospital Main Campus

1001 West Street
Carthage, NY 13619

(315) 493-1000

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Accredited by the Joint Commission

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