Pulmonary & Critical Care Associates, P.C.

 

Patient Forms


Pulmonary & Critical Care, P.C. Patient Form Jpeg

If you are visiting Pulmonary & Critical Care Associates, P.C., (PCCA) for the first time, for your convenience we offer our required medical forms for you to print and complete before your visit 

Patients who use our Patient Portal to complete their health history, should ignore the forms listed directly below and proceed to the Portal Patient Forms section further down the page and print/complete those forms.

General New Patient Forms

Portal Patient Forms

Once you have electronically completed the Health History forms via our Patient Portal, please print, fill out and bring with you to your appointment, the following forms:

Medical Records Release Forms

Click the link below to print a form to authorize the release of medical information TO PCCA.

Click the link below to print a form to authorize the release of medical information FROM PCCA to another provider/entity.

We have
4 locations throughout southeast lower Michigan


Shelby Township
50505 Schoenherr Road

Suite 290
Shelby Twp., MI 48315
Phone: 586-314-0080
Fax: 586-731-6253
     >>  Map  << 
 


St. Clair Shores
25319 Little Mack
St. Clair Shores, MI 48081
Phone: 586-772-5550
Fax: 586-772-1706
 
>>  Map  <<


Sterling Heights
44344 Dequindre
Suite 410
Sterling Heights, MI 48314
Phone: 586-262-5100
Fax: 586-262-5096
      >> Map <<
 


Roseville
25689 Kelly Road
Suite 100
Roseville, MI 48066
Phone: 586-445-5995
Fax: 586-445-5977
 
 >> Map <<