Phone: 248-896-6300
Fax: 248-896-6303
2300 Haggerty Rd., Suite 1000
West Bloomfield, MI 48323

Clouds

 

 
Forms
 

 

The following forms are for your convenience.

 
 


 

Accepted Insurances

It is important to be able to schedule treatment and care right away. That's why we offer CareCredit®, a healthcare credit card specifically designed to pay for treatments and procedures not covered by insurance. CareCredit has two unique features:
No Interest Payment Plans (if paid within the promotional period. Minimum monthly payments required) and Low Interest Payment Plans. For more information or to apply, please visit:

www.carecredit.com

Consent For Treatment

Medical Reconciliation Form

Pre-Admissions Form

Patient Satisfaction Survey

Michigan State Bar - Advanced Directive

Mandatory Advance Notice - New COP 2009

* Mandatory CMS Form - 2009

 

 

 
 

 

* Form must be brought in, signed, the day of service.

 

© 2009 Lakes Surgery Center