Schedule appointments at the Patient Portal.
Or call (248) 792-9881.
Please take a moment to print and fill out each form completely.
Patient Demographics Form: This form is general information on how we may contact you, your primary care physician’s information, and meaningful use questions. Please fill out completely.
Medical History Form: This form must be filled out to the best of your ability. It is important to be as complete and specific as possible when listing your medications, allergies, surgeries, past medical history, and current medical conditions. This form must be filled out and signed before seeing the physician.
Consent for Treatment: This form must be initialed at each paragraph and signed and dated at the bottom. By completing this form you give consent to become a patient of the practice. This form must be filled out and signed before seeing the physician.
The following two documents are for your records only and do not need to be brought to your appointment.
Office Policy and Procedures: This form goes over our payment policy, hours, and general policies of the office in detail. It also answers some “frequently asked questions”. Please note you do not have to fill anything out or sign this form, it is simply for your own personal records.