PATIENT FORMS
To help with the evalulation of your condition, we ask that you print out and complete the forms available through the links at right.

If this is a yearly exam, these forms are required to update your records annually. If you are a new patient to our office, they are necessary to establish your history and current physicial condition.

Please bring the completed forms and all insurance cards with you at your appointment time. If you do not complete the forms prior to your arrival, please plan to arrive 15 minutes earlier than your scheduled appointment time. This will allow you time to complete the necessary paperwork without delaying your visit.

INSURANCE and PAYMENT
Upon arrival to our office, please have all insurance cards available as we will take a copy for our file. As a courtesy to our patients, we bill all linsurance carriers for services. However, the responsibility for payment remains solely with you, the patient.  See our list of participating insurance companies at right.

Please inform our receptionist of any changes in your insurance coverage so that we can bill the appropriate carrier and avoid delays in payment. We ask that all insurance co-pays be made at the time of service.

We do participate with Medicare. However, you will be billed for your deductibles and the 20% co-insurance. If you have a secondary insurance and have provided us with that information, we will file a claim with that carrier after hearing from Medicare.


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PRINTABLE FORMS
Click on the names to open printable forms. 

New Patient Information, Male
New Patient Information, Female
Patient Demographic
History - Pediatric
Medications
Privacy Practices Receipt Acknowledgement
Patient Authorization for Disclosure
PARTICIPATING INSURANCE COMPANIES
Access Health
Aetna Managed Care Program
ASR/Physicians Care
BCBSMI
BC PPO
Blue Care Network
Blue Choice
Community Blue
Cigna
Cofinity
G.E.H.A.
Humana
LifeCircles
Little River
Medicaid (Straight)
Medicare (Traditional) and all Medicare Products Meridian
PPOM
Preferred Choices
Priority Health
Tricare