PATIENTS WILL BE SEEN BY APPOINTMENT ONLY.

Masks are required for all patients and visitors with upper respiratory symptoms, even with a negative COVID test.

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Offering Same-Day Appointments
Call to Schedule

Forms

Patient Forms

Before Your Appointment Card

  • Bring completed forms
  • Bring insurance card and photo ID
  • Bring medication list or bottles
  • Arrive 15 minutes early
View Forms

Find the right form faster

Use this page as a simple starting point for new patient paperwork, annual updates, sports physicals, and financial assistance information.

1. Download

Select the form you need and download or print it at home.

2. Complete

Fill out as much as you can before your appointment. Some sections may be reviewed with staff.

3. Bring With You

Bring your paperwork, insurance card, photo ID and medication information to your visit.

Patient Forms

Forms for new patients and registration updates.

Patient Information

General patient information.

Youth Sports Physicals – MHSAA

Sports physical paperwork for student athletes. A sports physical does not replace a well-child visit.

Discount Program

Information and application details for established patients who may qualify for reduced fees based on income and family size.

Learn More

Need help choosing a form?

Our team can help you find the correct paperwork before your appointment.

Bellaire Family Health Center
231-533-8649
East Jordan Family Health Center
231-536-2206

Please do not email completed medical forms unless instructed by our staff.

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Have questions before your visit?

Call your health center location and our team can help you prepare for your appointment.

Call Bellaire 231-533-8649Call East Jordan 231-536-2206

The Bellaire and East Jordan Family Health Center is experiencing issues with our internet systems. This has also impacted our East Jordan location phone systems. We are working to resolve this issue with Charter. Thank you for your patience.

The Patient Portal will be unavailable October 18-20, 2024 due to scheduled maintenance. We apologize for the inconvenience.