New Patient Registration Form
Consent to Use Email
Patient-Physician Partnership Agreement
Notice of Privacy Practices
Records Release (For new patients transferring into practice)
Authorization To Disclose PHI
Medical History
Financial Policy
Acknowledgement of Receipt of Privacy Practices
Records Release (For patients transferring out of practice)
Welcome to West Michigan Family Health
Medical and Family History
Social History
Records Release
PHI Release to Family Members
2120 43rd Street SE Suite 200Kentwood, MI 49508
Monday – Wednesday 8:30 am – 4:30 pm (lunch 12:30 – 1:30 pm)Thursday – Friday 8:30 am – 3:30 pm (lunch 12:30 – 1:30 pm)
Office Phone Number: (616) 455-4114Office Fax Number: (616) 455-4454Emergency After Hours Service Phone Number: (616) 391-9911
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