PATIENT FORMS
To expedite your visit – please read, download, (fill as noted,) print, and sign the following forms. Please bring the forms to our office or fax them to 1-734-462-1830. If you have any questions please contact our main office at 1-734-462-1525.
The Friedman Surgical Group accepts most major medical insurances. Please bring your medical card upon your visit, or call our main office to confirm coverage.
- Patient Intake Form Page 1 – Please print, fill, and bring to office.
- Patient Intake Form Page 2 – Please print, fill, and sign at office.
- Patient HIPAA Consent Form Part 1 – Please print, fill, and sign at office.
- Patient HIPAA Consent Form Part 2 – Please print, fill, and sign at office.
- Disability Paperwork Processing Fees Notice– Please print, fill, and sign at office.
Thank You!
Friedman Surgical Group
Friedman Surgical Group
All forms revised 08/15/2024