To expedite your first appointment, please arrive a few minutes early to complete registration forms so that we have all the necessary information to treat your child. You may also download and print the forms from this website, fill them out ahead of time, and bring them with you to the first appointment.
New Patient Forms
- Patient Demographics
- Receipt & Notice of Privacy Information Practices
- Consent to Treat
- Patient History
- HIPPA Form
- Pharmacy Information
Other Documents
We ask that you please complete the patient information and health history section before we fill out a form.
Henry Ford Macomb Health Center - Chesterfield
30795 23 Mile Rd, Suite 202
Chesterfield Twp, MI 48047
Phone: (586) 421-1740
Fax: (586)-421-1744
Office Hours
Monday: 8AM – 5PM
Tuesday-Friday: 8:30 AM – 5PM
*Saturday: 8:30 AM- 12PM
*(every 1st & 3rd)
Sunday: Closed
Phones on daily: 8 AM - 4:30 PM
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Contact Info &
Office Hours
Location
30795 23 Mile Rd, Suite 202
Chesterfield Twp, MI 48047
Phone
(586) 421-1740
FAX
(586) 421-1744
Hours
Monday: 8AM – 5PM
Tuesday-Friday: 8:30 AM – 5PM
*Saturday: 8:30 AM- 12PM
*(every 1st & 3rd)
Sunday: Closed