Forms:
To prepare for your initial appointment, please review and complete the following forms. If you have any questions, call (734) 219-3878 or email dr.francis@zerobarriers.net.
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 documents@zerobarriers.net