Patient Forms

Auto Accident

Used to collect information about a patient’s motor vehicle accident and insurance details for medical evaluation and billing.

Health History

Captures a patient’s past and current medical conditions, medications, allergies, and lifestyle information to guide care.

Medical Records Release

Authorizes the transfer or sharing of a patient’s medical records between healthcare providers or facilities.

MPG Financial Policy

Explains the clinic’s billing, payment, and insurance policies that patients must acknowledge before receiving care.

Patient Consent Form

Grants permission for evaluation, treatment, and communication of health information as required for care.

Patient Demographics

Collects basic identifying information such as name, address, contact details, and insurance coverage.

Privacy Practices and Authorization

Outlines how personal health information is used and shared in compliance with HIPAA regulations.

Patient Provider Agreement Gastroenterology

Macomb Physicians Group is a medical group practice located in Sterling Heights, MI that specializes in Internal Medicine and Family Medicine.

Patient Provider Agreement-Neurology

Details the terms of neurological care, outlining both patient and provider responsibilities.

Patient Provider Agreement-OB GYN

Explains the care relationship and policies for obstetric and gynecologic services.

Patient Provider Agreement-Primary Care

Establishes mutual expectations for ongoing primary care management and communication.

Physical Form

Documents examination results and health clearance for employment, school, or sports participation.

Workers Comp

Records details about a workplace injury and employer insurance to coordinate medical treatment and claims.

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