Patient Info
New Patient History Form
Please print off this form and fax a completed copy to (517) 324-7193. Forms must be submitted prior to your appointment.
No Show/ Cancellation Policy
If you cancel an appointment with less than 24 hours or you do not appear for your scheduled appointment you will be charged a $20 fee.
Other Forms
- Authorization for Release of Medical Information
- Insurance Participation List
- Notice of Privacy Policies
- Patient Information
- Policies
- Tinnitus History Questionnaire
- Tinnitus Reaction Questionnaire