Get an Appointment | Schneider Regional Medical Center

Outpatient Services

Admitting Package

Please complete the Admitting Package. Download it from the following link, complete it, print it, and bring it with you to your appointment.

Admitting Package

Myrah Keating Smith Food Handlers Card

Additional Documentation

"Excellent patient care, is the priority". A most critical responsibility of the department is to receive, analyze, and implement suggestions or recommendations with the goal to enhance the quality of services.

After you submit the form, a care specialist will call you back to schedule an appointment.

You may also speak with a care specialist directly by calling 340-776-8311, extensions 2157, 2168, 2171, and 2211 to schedule your appointment or for more information. Specialists are available Monday–Friday between 8:30 am and 5:00 pm AST.

Who are you?

Patient

Caregiver

What is your relationship to the patient?

Your Information

Your First Name*

Your Last Name*

Your Email*

Your Phone*

Your Phone Preferences

Please select the best days and times for us to call you.
Leave blank if you have no preferences.

Day of the Week	Time of Day
Day of the Week	Time of Day
Day of the Week	Time of Day
Day of the Week	Time of Day

Patient Information

Patient First Name*

Patient Last Name*

Patient Email*

Patient Phone*

Patient Phone Preferences

Please select the best days and times for us to call the patient.
Leave blank if the patient has no preferences.'

Day of the Week	Time of Day
Day of the Week	Time of Day
Day of the Week	Time of Day
Day of the Week	Time of Day

Appointment Information (optional)

Please provide information about your medical needs

Please provide insurance plan name information'

Have you been referred by a physician?

Please provide information about the referring physician

Outpatient Services

Admitting Package

Please complete the Admitting Package. Download it from the following link, complete it, print it, and bring it with you to your appointment.

Admitting Package

Additional Documentation