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For your convenience, our on-line forms are a great way to quickly
and conveniently obtain forms from our office. Many of our patients
find that it is more relaxing to fill out the necessary forms prior
to coming into our office. Please call us if there is a form you need
that is not available below.
Patient History & Physical Form
Consent for Release of Protected Health Information
Payment Plan
Authorization Agreement for Pre-Authorized Collections
Print form and fax to Cardiology Institute of Michigan at 810-733-8740
If applicable, Cardiology Institute of Michigan offers a payment plan
adjusted to your needs. We can automatically debit your bank account
on a monthly basis on the date of your choice. Please contact our patient
account representative if you would like more detail.
Returned Checks - There is a $30.00 fee for any returned
checks in addition to any fees your financial institution may charge.
Download Form
Payment by Credit Card
You may call our Business Office between the hours of 8:30 AM to 4:30
PM EST to make a payment to your account. The phone number is 810-762-1820
Cardiology Institute of Michigan accepts MasterCard, Visa, Discover and American
Express for payments to accounts. Please have your credit card available when
calling to make a credit card payment over the phone.
Helpful Links
American
Heart Institute
American College of Cardiology
Pacemaker/Defribrilator
Patient Information
Women's Health & Heart Disease
Diseases and Conditions Index
Smoking & Health Risks |
