New Patient, GYN Packet
New Patient, OB Packet
Established Patient, OB Packet
Advance Patient Notice
Confidential Communication of Protected Health Information
Edinburgh Depression Scale
Financial Policy
FMLA/Disability Form Request
Insurance Information
FMLA/Disability Checklist
Medical Records Release
Notice of Privacy Practices Acknowledgement
Physician Request Form
Main Campus
(517) 484-3000 fax: (517) 484-6358
1560 Turf Lane, East Lansing, MI 48823
South Campus
1100 South Cedar Street, Mason, MI 48854
Medical Records
Processed in house at Alliance
Release of Protected Health Information (jotform.com)
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