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.
Authorization to Evaluate, Treat, and Release Records
Patient Rights and Responsibilities
Acknowledgement of Receipt of Patient Rights and Responsibilities
Notice of Privacy Practices (HIPAA)
Adult Health History Form and Allergy/Medication Log
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 may apply for our reduced fee for services (Sliding Scale). Please bring verification of income such as pay stubs, social security or disability payment letter, W-2 forms, or a letter from your employer in addition to $15. If you do not apply for our sliding scale, plan on paying for your appointment in full.
Application for Discounted Services
Page last modified September 5, 2012
