GVSU Family Health Center

What to Bring to Your First Appointment

The following are necessary forms that must be filled out prior to being seen at our office. Please carefully review and complete these documents and bring them to your first appointment.

Demographic Sheet

Authorization to Evaluate, Treat, and Release Records

Patient Rights and Responsibilities

Acknowledgement of Receipt of Patient Rights and Responsibilities

Notice of Privacy Practices (HIPAA)

One of the Following:

Health History Form Under 1 Year Old

Health History Form 1 to 17 Years Old

Health History Form 18 Years old and Up

 

Bring your insurance card and any co-payment that is your responsibility to pay in accordance with your insurance policy.

If you do not have insurance, you will be required to pay $130 prior to your visit.  If your visit is less than $130, you will be issued a refund by mail.  If it is more than $130, you will be billed for the difference.

Page last modified February 28, 2014