Sometimes we need extra information to coordinate your care — whether it’s for an MRI, a medication request, or updating your health history. Use the forms below to submit details quickly and securely, so we can process your request without delay.
Prior Authorization Request
Some medications and imaging require extra approval from your insurance company. We’ll do the work on our end to advocate for the care we recommend, but the final coverage decision is made by your insurance company.
MRI
CT (CAT) Scan
GLP-1 (Ozempic/Wegovy, Mounjaro/Zepbound, etc)
Getting Started Forms
Complete these forms to help us learn about your health history, lifestyle, and goals before your first visit.
New Patient Intake Form:
Medical Record Release Form:
Insurance Information:
Health Forms & Screenings
Please only complete these forms if requested by our office before your annual physical or a specific visit. They help us better understand your symptoms, risks, and current health needs.
PHQ9 & GAD7 :
Adult ADHD Self-Report Scale:
Lifestyle Intake Form:
Pittsburgh Sleep Quality Index:
STOP-BANG Score for Obstructive Sleep Apnea:
At Direct Primary Care of West Michigan, you are not just a patient, you are part of our family.
