To prepare for your initial appointment, please review and complete the following forms. If you have any questions, call (734) 219-3878 or email

Download & Print Forms:

Telemedicine Consent Form

Explains how we conduct video appointments and your rights as a patient.

HIPAA Notice of Privacy Practices

Explains how we protect your confidential health information.

HIPAA Authorization for Use or Disclosure of Health Information

Allows you to share your information with a specific third party (e.g., another doctor).

Consent for Treatment

Outlines your rights and responsibilities as a patient and confirms your agreement to receive treatment.

Complete & Submit Forms:

  • Fill the forms out by hand and sign them.
  • Scan or take a clear picture of the completed forms.
  • Email your completed forms to