New Patient Center

Thank you for taking the time to fill out your forms in advance. Please fill out our online form below, then click on the links below to print the following required forms:

STEP 1

We would like to know you better. Please provide us with your answers to the following questions.

We Accept The Following Insurance Programs
  • Aetna U.S. Healthcare – EPO, POS, PPO
  • Beaumont Employee Health Plan – PPO – UMR
  • Beaumont Services Company (BSC) – PPO – UMR
  • Beech Street – PPO
  • Blue Care Network – HMO
  • Blue Cross/Blue Shield – Traditional
  • Blue Cross/Blue Shiels PPO – (Blue Preferred, Blue Preferred Plus, Community Blue)
  • Cigna
  • Cofinity (PPOM) – Total Health Care PPO
  • DirectCare America (Chandler Group) – PPO Formerly Primary Health Services
  • Great West – POS, PPO
  • HAP Medicare PPO
  • HAP PHP
  • HAP HMO (Not Henry Ford)
  • Humana Choice Care PPO (Choice Care)
  • McLaren PPO Health   POS – Must have PCP, but do not need a referral
  • Medicare
  • Medicare Aetna Open Plan – PPO
  • Medicare Plus Blue – PPO
  • MultiPlan – EPO, POS, PPO
  • Priority Health – PPO & HMO HMO does not need a referral
  • Private Healthcare System (PHCS) – EPO, POS, PPO
  • Tricare Standard (formerly Champus)
  • Tricare for Life (Medicare portion)
  • United Healthcare – EPO, POS, PPO
  • United Physicians Health Insurance Plan – PPO (UPHIP)

STEP 2

Please take a moment to print and fill out the forms below and bring with you to your initial visit with us.

If your son or daughter is under the age of 18 but coming to their appointment without a parent, you can click on Treatment to minors, print this form out and send it with your child so we may treat them in your absence.