Patient Forms

 

New patients will need to fill out several forms before services can begin. To make the process as smooth and efficient as possible, we provide access to the most important documents via our secure portal right here via our website.

 

Returning the completed documents to our practice in advance saves time.

If you are unsure which forms to fill out, don't hesitate to contact us.

 

New/Annual Patient Paperwork

2024 PAPERWORK

Annual Patient Paperwork 2024:

Patient Information 2024

Release of Information PCP (required for all patients):

Release of Information for Primary Care Physician

Annual Patient Information Without Changes:

Annual Patient Information Without Any Changes Form

Updates Only

Forms needed when there are changes and you need to update only select information with us - insurance or address - not all of your information.

Insurance & ID Information:  

Insurance & ID form

Optional Forms

Needed when you want us to communicate with anyone - family, providers other than your PCP (for example, specialists).

Release of Information:  

Release of Information Form

Release of Information - Bariatric Surgeon:  

Release of Information Form

Payments

Securely pay a portion or total of your account balance

Patient Balance Payment:  

Pay your bill balance securely

Credit Card on File Form:  

Update your credit card on file

Where to Find Us

Total Health & Wellness Associates

  • 23580 Orchard Lake Road  Farmington Hills, MI 48336
  • 245 Barclay Circle. Suite 400  Rochester Hills, MI 48307
  • 432 N. Saginaw St. Suite 433  Flint, MI 48502

Phone: (248) 957-6444

Email: admin@mytotalhealth.care

Or use our Contact Form.

 

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Patient Forms

New patient? Save time and reduce the amount of paperwork you have to fill out at your first visit. We provide access to the most important documents via our secure portal right here via our website.

Click Here 

WE ACCEPT MOST INSURANCES AND SELF-PAY