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

2023 PAPERWORK

Patient Information 2023:

https://forms.myupdox.com/form/121573

Release of Information PCP:

https://forms.myupdox.com/form/120057

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 Info:  

https://forms.myupdox.com/form/120693

Optional Forms

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

Release of Information:  

https://forms.myupdox.com/form/120059

Release of Information - Bariatric Surgeon:  

https://forms.myupdox.com/form/120059

Payments

Securely pay a portion or total of your account balance

Patient Balance Payment:  

https://forms.myupdox.com/form/125678

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