ONLINE FORMS Click on the FORM NAME and the file will be displayed in your browser. Fill Them Out Completely, Print Them Out and Bring Them To Your Appointment. DOWNLOADABLE FORMS Click on the FORM NAME (downloadable file) and the file will be downloaded to your computer or Click on a Patient Forms Packet then all forms within that packet will be downloaded then you can Print the Forms, Fill Them Out Completely and Bring Them To Your Appointment. Patient Forms Packet A - New Patient 18 and over: Office Visit Only • Adult New Patient Questionnaire-Online Form (or the downloadable file) • Patient Information Form-Online Form (or the downloadable file) • Authorization/Agreement Treatment, Insurance & Financial Responsibility (or the downloadable file) • Consent to Use and Disclose Protected Health Information-Online Form (or the downloadable file) • Notice of Stonebrooke's Privacy Practices for Protected Health Information Online Form (or the downloadable file) Patient Forms Packet B - New Patient 18 and over: Complete Physical Examination • Adult New Patient Questionnaire-Online Form (or the downloadable file) • Patient Information Form-Online Form (or the downloadable file) • Authorization/Agreement Treatment, Insurance & Financial Responsibility (or the downloadable file) • Consent to Use and Disclose Protected Health Information-Online Form (or the downloadable file) • Notice of Stonebrooke's Privacy Practices for Protected Health Information Online Form (or the downloadable file) • Complete Physical Examination Consent Form - Online Form (downloadable file) • Review of Symptoms Form-Online Form (downloadable file) Patient Forms Packet C - New Patient under 18: Any Visit Type • Pediatric New Patient Questionnaire- Online Form (or the downloadable file) • Patient Information Form-Online Form (or the downloadable file) • Authorization/Agreement Treatment, Insurance & Financial Responsibility (or the downloadable file) • Consent to Use and Disclose Protected Health Information-Online Form (or the downloadable file) Patient Forms Packet D - Established Patient: Complete Physical Examination • Complete Physical Examination Consent Form - Online Form (downloadable file) • Review of Symptoms Form-Online Form (downloadable file)

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Family Physicians

Rochester Hills Area, Troy Area, Rochester, Utica, Pontiac, Bloomfield Hills

We are a state of the art medical facility designed to suit the needs of your busy family.

Our mission is to provide high quality health care services for the entire family from newborns to elderly adults in a friendly and comfortable setting.

We understand the time constraints of modern life and offer multiple means of access for your medical care with convenient hours, two locations, and multiple on-site services to maximize the efficiency of your care without having to sacrifice quality.

2940 Crooks Road
Rochester Hills
Michigan 48309
(248) 997-9700
fax: (248) 997-9707

Dr. Haener

Dr. Bellisario

Dr. Kastl

Dr. Ewald