LFM Forms

To process the following forms in a timely manner, please complete all required information.  If you have any questions, please contact our office at 616-396-6516.

Authorization for Completion of Forms {click here for fillable/printable form}
Please fill out this Authorization when you need any form completed. (i.e. FMLA, disability, handicap sticker, school/sports forms, employer forms) Return completed Authorization* and form to LFM. Allow 5 business days for completion of form. There may be a fee for completion of your form.

Authorization for Release of Medical Records {click here for fillable/printable form}
Please fill out this Authorization when you want LFM to send any of your medical information anywhere. (i.e. employer, school, another person, written letters, transfer to new PCP) Return completed Authorization* to LFM. Allow 10 business days to send records.

* Incomplete authorizations will cause a delay in processing your request
** Please call 616-796-3423 with any questions regarding completing these Authorization forms.

New Patient Packet {click here for fillable/printable form}

New Patient (Minor) Packet {click here for fillable/printable form}