Mercy Health Physician Partners Grand Rapids


 

Patient Forms

Whether you are a new or current member of Mercy Health Physician Partners, here is where you’ll find all the forms and releases you’ll need to make your care as seamless as possible. If you are new to our network, please complete all of the following applicable forms and return them to us before or on the day of your first visit with your Mercy Health Physician Partners physician.

Please note that our require official signatures. You can print and fill out the forms by hand, or type in the required information, print and sign.

Privacy Policy
(read before signing the Patient Registration/HIPAA Forms below)

Patient Registration/Consent for Treatment/HIPAA


Medical Record Authorization to Disclose Protected Health Information


Treatment of Minor Consent


Deceased Patient Representative/Heir/Beneficiary Request


Workers' Compensation & Auto Claim