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Patient Forms

Advance Directives

See Designating a Patient Advocate.

Medical Records

To request a copy of your patient records, see Medical Records

  • Designation of Release of Health Information (PDF 70 KB) - Use this form to give your doctor's office permission to share your medical information with other people, such as family members.
  • Medical Data Record (PDF, 32 KB) - Write down your medications, allergies and other important health information to carry with you.

New Patient Forms

  • MPG Financial Policy (PDF 28 KB) - MidMichigan Physicians Group asks new patients to read and sign this policy prior to establishing themselves as a patient in the practice.

Pediatric Forms

  • Consent for Treatment of a Minor Child (PDF, 68 KB) - Sign this form and give it to a babysitter, relative, school chaperone or anyone who is responsible for your child while you are away. That person will need to present this form to get medical, dental or hospital care for your child if you cannot be reached.
  • Refusal to Consent to Vaccination - A doctor may require you to sign this form if you decline to have your child vaccinated according to the recommended schedule. If your child's vaccinations are not up to date, many schools, camps or other programs may also require you to sign a Vaccination Waiver before enrolling your child. Signing a waiver does not guarantee that your child will not be excluded.
  • Sports physicals - This form is required by many school and private sports programs. Complete the student and parent portions of this form and bring it with you to your scheduled sports physical.

How Do I Call a Patient?

For patient privacy, we do not give out direct phone numbers to patient rooms. Please call the switchboard numbers below and ask for the patient by full name. Please keep in mind that patients may elect not to receive phone calls. See more ways to stay in touch.

Medical Centers

Clare (989) 802-5000

Gladwin (989) 426-9286

Gratiot (Alma) (989) 463-1101

Midland (989) 839-3000


Nursing Homes

Gladwin Pines (989) 426-3430

Stratford Village (989) 633-5350