Patient Forms

The following patient forms are mailed out before your first appointment and are also available for you to download for your convenience. Each must be filled out before your first appointment OR if you have not been seen by our doctors within a year.

You may need to download Adobe Acrobat to view these files. Click here getadobereader to download the reader from Adobe.com.  (Be sure to uncheck the box for the optional software unless you wish to install it.)


New/Annual Registration:
This form includes New Patient Information, Consent to Share Medical Information, Notice of Privacy Practices, and Financial Policy.

Great Lakes Surgical Finacial Policy: (Click Here) or scan the code below.

 

HIPPA Notice of Privacy Practices (Click Here) or scan the code below.

Patient Information (Click Here) or scan the code below.

Patient Medical History (Click Here) or scan the code below.

Patient Release of Information (Click Here) or scan the code below.

Social Determinants of Health (Click Here) or scan the code below.

Non-Discrimination Notice – Language Assistance Services – Grievance Procedure

GLSA does not discriminate. Please read our non-discrimination policy listed below.

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