• Home
  • About
    • Careers
    • Clinics
    • Departments
    • Our Mission, Vision and Values
    • Leadership
    • Volunteer
    • Service Price List
  • Services
    • ICH Services
  • Patients & Visitors
    • Available Forms
  • Providers
  • News
  • Contact
  • Patient Portal
  • Careers
  • Bill Pay
  • Patient Portal

Available Forms

Click on any of the following forms to download a copy.

Patient Pre-Registration Form

One Time Credit Card Payment Authorization Form

ACH Payment Plan Authorization Form

Recurring Payment Authorization Form

Authorization for Disclosure of Health Information Form (Irwin Family Medicine)

Release of Information Authorization Form (Irwin County Hospital / Palmon Gaskins Nursing Home)

Irwin County Hospital

710 N Irwin Ave
Ocilla, GA. 31774

© 2021 Irwin County Hospital | All Rights Reserved

Call us

Phone: 229-468-3800

Email us

info@remove-thisirwincntyhospital.com

Quick links

  • About
  • Services
  • Patients & Visitors
  • Providers
  • News
  • Contact
  • Patient Portal
  • Careers

Proud Partner

Accreditation