Student Consent Form
We are excited to invite you to enroll your child in the School-Based Health Program. Your child has the opportunity to be examined, diagnosed, and treated by a provider from Bamberg Family Practice while at school via telehealth. Advantages of the program include reduced missed class time for students and reduced missed work for parents or guardians.
Please note that your child may receive medical care from the telehealth provider at Bamberg Family Practice. Utilizing this service will not make your child a patient of Bamberg Family Practice. We will make sure to update your child’s current primary care physician of any visit.
To enroll, please complete the school-based health consent form below. Insurance carriers are billed for, and copays and deductibles apply. SC Medicaid covers the visits. Other insurance companies may vary. Please consult your insurance carrier if you have questions about coverage.
For questions about the program, please contact our Telehealth Provider, Crystal Williams, FNP-C at (803) 245-5168 ext 104.
F. MARION DWIGHT, MD, PA BAMBERG FAMILY PRACTICE 2113 MAIN HWY. • PO BOX 120 BAMBERG, SC 29003 803-245-5168