Forms Library

The world seems to run on forms these days. Here is a collection of some commonly used forms. Please download and print the form you need and bring it to your next appointment. We will be adding to this as time progresses. Click on the name of the form. You may need Adobe Reader for these (click here for Adobe Reader).
 
Our Office Forms - Electronic forms on our website that provide us with your information and medical, surgical and family history.  
  
State of Michigan School Physical Form - Print and bring this to the office for the yearly physical if changing schools.

State of Michigan Sports Physical Form - Print and bring this to the office for sports physicals.
 
Disability Parking Permit Application - If you have a disability that makes it difficult to walk across parking lots, print this and bring to your next appointment.
 
Family Medical Leave Act Form - If you have to miss work for a period of time due to your own health problems or to care for a sick loved one, you may need to present this form to your employer. If you or your sick loved one are pateints of ours, please print this and bring to your next appointment.

Advanced Care Planning - This is a collection of forms from United Physicians that will help patients and families plan ahead for their medical future.
 
Durable Power of Attorney for Health Care - Everyone should decide who will make medical decisions for them if they are unable to speak for themselves. Print this and document who shall make decisions on your behalf. Give a copy to your chosen decision maker and give us a copy for your chart.
 
Living Will - If you are unable to speak for yourself during a time of life and death decision making, it is helpful to have your wishes documented to guide those who will make decisions on your behalf. Fill this out, give it to your chosen decision maker(s) and give us a copy for your chart.
 
Blue Care Network Qualification Form - BCN patients may be required to have us fill these out. If so, bring this in for us at your next check-up.

Blue Cross Blue Shield of Michigan Qualification Form - BCBS patients may be required to have us fill these out once a year.