3537 West Front Street, Suite I, Traverse City, MI 49684
231.935.8950  phone
231.935.8868  fax
  Premiere Center for Adult Medical Services

Registration

New Patients:

  • Bring current insurance cards
  • Bring photo identification such as drivers license
  • Complete registration information (see below)
  • Complete medical records release (see below)

Established Patients:

  • Bring current insurance cards to all appointments
  • For physicals (annual preventive care visits), please fast for 10-12 hours before your appointment in order to complete any lab work your doctor may order (drink plenty of water and take your usual medications)

Asterisked (*) forms may be completed and submitted online via our secure server. All forms may also be printed, completed, and brought to your appointment.

Use the Tab key or your mouse, not the Return/Enter key, to move between each section/field. Pressing the Return/Enter key will submit the form.

Registration Information* (new patients/current patients with insurance changes)
Physical Questionnaire* (all patients)
Medical Records Release (any patient)

 

Electronically submitted forms (*) will be validated and signed at the time of your visit.

By submitting an electronic form (*) you are giving consent for them to be sent across secure Internet lines.

All forms are protected under Copyright law; any unauthorized use is prohibited.