6000 24 Mile Road, Shelby Township, Michigan 48316

Appointments: 586-884-6702

Appointments: 586-884-6702

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    • Home
    • OFFICE INFO
    • Our Providers
    • Forms
    • Patient Resources
    • Healthy Living
    • ONLINE BILL PAY
    • patient portal
  • Home
  • OFFICE INFO
  • Our Providers
  • Forms
  • Patient Resources
  • Healthy Living
  • ONLINE BILL PAY
  • patient portal
Partners in Family Medicine

Your Patient Centered Medical Home

Your Patient Centered Medical HomeYour Patient Centered Medical Home

New patient forms

Print and complete the following 5 New Patient forms and bring them along with your current medication bottles to your appointment.  

If you cannot bring the bottles, bring a list of your current medications including dosage to your first appointment.  

You can find our HIPAA policy listed below for your reference.

Patient Demographic form (pdf)Download
Office Policies for patients (pdf)Download
Patient Consent (pdf)Download
PCMH Agreement (pdf)Download
Release of Information (pdf)Download

Releases

Print and return the medical release form to our office if you need your medical record sent or requested to/from another healthcare provider.

Medical Records release to PFM (pdf)Download
Release of Information (pdf)Download
Medical Records release to another provider (pdf)Download

Billing

Auto Claim form (pdf)Download

HIPAA Privacy Notice

HIPAA Notice (pdf)Download

Copyright © 2018 Partners in Family Medicine - All Rights Reserved.


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