New Patient Registration

New Patient Registration Form

For 15 years our practice has been serving the family medical needs of newborns to seniors in our area. We are glad that you are interested in learning more about us and in entrusting your family’s health to us. We want to make the process of accessing healthcare as easy and as fast as possible for all of our new patients.

Our practice needs your contact, insurance, and medical history information before your first appointment. There are policies and other information we will also need for you to review and sign before your first visit. To make this easier, NEW patients can download, print and fill out the forms before your scheduled appointment. This will allow you to check-in for your appointment with all of the necessary paperwork already completed which allows our staff to provide you with FASTER service.

We can also mail, email or fax the forms to you so you can fill them in by hand and return them to us. If you have any questions about these forms please feel free to contact the EPIC Care Coordination Team at (248)336-4000.

Forms for Patients

This includes: New Patient Registration form, Designation of Personal Representative, Notice of Privacy Practices, E-prescribe Form, Release of Medical Information, Patient-Centered Medical Home Agreement.

This includes: New Patient Registration form, Designation of Personal Representative, Notice of Privacy Practices, E-prescribe Form, Release of Medical Information, Patient-Centered Medical Home Agreement.

1.  Patient NOTICE OF PRIVACY Forms

My EPIC Primary Care Chart – Patient Portal

We’re excited to offer a new online tool that provides anywhere, anytime access to your personal health records! With our new patient portal, you can manage your health, and make more informed decisions about your care – 24/7 from any computer, smartphone or tablet.

• Review your medical records online in a safe, secure environment
• Update your health information (allergies, medications, conditions, etc)
• Request Rx refills
• Receive email care reminders
• Request appointments
• Create proxy accounts for children or dependent adults

Request your personal My EPIC Primary Care Chart login

Making the Most of your Appointment

The time you have with your EPIC Primary Care doctor is very important to your health. So be sure to ask questions, explain any new symptoms or problems and share your concerns. Here are some ways to help you get ready for your next appointment:

• Make a list of your questions and concerns. Put your most important ones at the top of your list.
• Make a list of all the medications you are taking to give to your doctor. This includes drugs (prescription and non-prescription), vitamins, and other natural remedies such as herbal products. Some people bring all their pill bottles in a bag for the doctor to see.

• Call your EPIC Care Coordination team about health screenings and vaccinations. Ask questions if you are not sure which screenings or shots you need and how often you need them.
• Ask a friend or family member to come with you, if you think it will be helpful. This person can help listen, take notes and offer support.

We have a companion checklist for you to use during your visit. View it here.