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:
Release of Information PCP:
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:
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 - Bariatric Surgeon:
Payments
Securely pay a portion or total of your account balance
Patient Balance Payment:
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.
WE ACCEPT MOST INSURANCES AND SELF-PAY
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