34815 W. Michigan Avenue, Wayne MI 48184 Tel. (734) 721-4739 Fax (734) 725-3184
34815 W. Michigan Avenue, Wayne MI 48184 Tel. (734) 721-4739 Fax (734) 725-3184
If you would like to print and fill out required forms prior to your visit, you may download them here and bring them with you on the day of your appointment.
New Patient Form (pdf)
DownloadReturn Patient Packet (pdf)
DownloadHealth Information Release Form (pdf)
DownloadPatient Authorization for Disclosure of PHI (pdf)
DownloadVirtual Appointment Consent Form (pdf)
DownloadBotox Office Policy and Consent Form (pdf)
DownloadConsent for Procedure (REQUIRED for all EMG and Injection patients) (pdf)
DownloadConsent for Skin Biopsy (pdf)
DownloadTest Preparation Sheet (pdf)
DownloadWe love our customers and are glad to give a helping hand.
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