The information and forms on this page apply to these health centers:

  1. Big Rapids
  2. Irwin/Martin (in Grand Rapids)
  3. Marquette
  4. Muskegon
  5. Petoskey
  6. Walker (in Traverse City)

If your health center is not listed above, access the forms for our Mid and South region.

If you are a new client or an established client coming in for an annual exam, you can save time at your appointment by setting up an online patient portal account and filling out your forms electronically. Or you may print and complete the three forms below and bring them with you to your visit.

All forms must be filled out in BLACK INK.

If you need your health records transferred, please call your health center directly to obtain a Release of Information form.


Patient Forms

Funding Application

This form requests information from you to assist us in possibly securing funding to help cover the cost for your services. Please fill out this form in black ink.

Get Funding Application PDF in Spanish.

Get Funding Application Form (PDF)

Patient Rights, Responsibilities, and Billing Policies

This form describes your rights as a client; and the responsibilities of both PPMI and you, when it comes to your medical care. It also provides you with information regarding our billing policies, depending on your particular funding program or health insurance plan. Please fill out this form in black ink.

Get Patient Rights, Responsibilities, and Billing Policies PDF form in Spanish.

Get Patient Rights Form (PDF)

Electronic Communication Consent

This form requests your consent to receive electronic communications from PPMI. Please fill out this form in black ink.

Get Electronic Communication Consent PDF in Spanish.

Get Electronic Communication Consent (PDF)