Forms

Please take a moment to print and complete the following forms and bring them with you to your scheduled appointment.
To view these documents, you will need Adobe Reader

Patient Information Form
Patient History Form
Grand Blanc Practice Policies Statement
Lapeer Practice Policies Statement
HIPAA Information Form
Confidential Communication Authorization Form

It is very important that you fill them out COMPLETELY for us to have all of the necessary information.  Please be at least 15 minutes early for your scheduled appointment.  If you are more than 15 minutes late you will be rescheduled.

INSURANCE NOTICE

If your insurance requires a referral for your doctor office visit (Health Plus, Genesee Health Plan, etc.) you must make sure that you have a referral for each date of service that you see your doctor.  You can have your primary care physician fax it to our office  at 810-953-8704 or you can bring it in with you on the date of the scheduled appointment.  WE MUST HAVE A GOOD REFERRAL AT THE TIME OF YOUR APPOINTMENT EACH TIME YOU SEE OUR DOCTOR.  If you do not have a current updated referral, your appointment WILL be rescheduled.   Please be sure to check the expiration dates. 

Please do not hesitate to call us if you have any questions or concerns. 

Thank you!