FORMS
Patient Information
On your first visit please arrive 30 minutes prior to your scheduled appointment time. Print and bring the completed forms found on this page. If your insurance requires a referral please bring it to your appointment.
We look forward to meeting you!
Urgent / Emergency After Hours Information – If there is a medical emergency dial 911. If you have urgent concerns that occur after office hours please call our office at 248-656-2022 and you will be routed to our answering service.
Please note, medication refills are completed during normal business hours only.
Please bring the following items to your appointment:
- Completed forms from this page
- Valid Driver’s License or State ID
- Insurance card(s)
- List of medications you take on a regular basis, including over-the-counter medications & vitamins
- List of surgeries or medical procedures you have had
- Payment for your co-pay or any non-covered services. (Cash, Check, VISA, MasterCard, or Discover)
Financial Policy
- All copays, deductibles, and non-covered service charges are due at the time of service.
- There is a $10 per month statement fee for all balances over 30 days.
- There is a $5 fee to complete forms for disability, insurance, FMLA, etc., which is required before the forms can be completed.
- NSF checks are charged $35.
LOCATION
1135 W. University, Suite 100
Rochester Hills, MI 48307
