Patient Forms

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Patient Registration Form
Patient Appointment Reminder
Adult Health History
Child Health History
Consent to Treat
Sliding Fee Application
Acknowledgment of Privacy Practices
Record Release Form

Existing Patient
Patient Questionnaire
Sliding Fee Application
Record Release Form

Dental Forms
Dental Form

For any questions call us at 586.619.9986 – Monday to Friday: 8am – 5pm

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MyCare Health Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,878.869 with 69% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

Federal, State and/or Local funding has been provided through Macomb County Community Mental Health/Office of Substance Abuse to support Medication Assisted Treatment program costs

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