Your completed paperwork must be received prior to September 28th to secure your appointment time.



To complete the online form and send by email:
1. Click here to download the form.
2. Save the form to your computer.
3. Complete the fillable form, page one only.
Please note your requested time of appointment. You make select: 7:30am - 7:45am,
7:45am - 8:00am, 8:00am - 8:15am, 8:15am - 8:30am, 8:30am - 8:45am. If your requested time is not available one will be
assigned for you and you will be notified, preferrably by email.

4. Attach the form to an email and send to: jasmith@syringahospital.org
5. A copy of the form will be provided for you at the event.



To print the form and send by U.S. Mail or to drop off in person:

1. Click here to download the two page registration form.
2. Print the form.
3. Complete the form by hand, page one only. Please note your requested time of appointment. You make select: 7:30am - 7:45am,
7:45am - 8:00am, 8:00am - 8:15am, 8:15am - 8:30am, 8:30am - 8:45am. If your requested time is not available one will be
assigned for you and you will be notified, preferrably by email.

4. Send the completed form to: ATTN: Jo Anne Smith, SHC, 607 W. Main Street, Grangeville, ID 83530.
OR
Drop off the form in person: Syringa Hospital located at 607 W. Main Street , Grangeville; or Syringa Kooskia Clinic located at 022
N. Main Street, Kooskia.
​5. A copy of the form will be provided for you at the event.


Contact Jo Anne Smith with any questions: jasmith@syringahospital.org (208) 507-0720.