Patient History Form
Please carefully read and complete the form to the best of your knowledge at least one week prior to your visit. Additionally, please mail, email or fax any relevant medical records (Mail: 3031 West Grand Blvd. New Center One, Suite 700, Detroit, Michigan 48202; fax to (313) 916-1730 or email to firstname.lastname@example.org) and bring any imaging disks for X-rays, CT scans, MRIs etc. with you to the appointment. Do not hesitate to contact us with any questions at (313) 916-2723.