Forms & Articles
New Patient Forms
Please complete and return to: Little Traverse Primary Care, 8881 M-119 Hwy, Harbor Springs, MI 49740, fax to 231-348-2515, or you can drop the paperwork off at any LTPC branch. If you are unable to return your paperwork prior to your scheduled appointment, please arrive 15 minutes early so we have time to process your paperwork.
- Authorization for Release of Patient Information– Please complete if you are transferring care or want information sent to/from another physician/clinic
- Authorization for Exchange of Patient Information – Please complete if you want someone else (i.e. family member) to be able to communicate with us regarding your healthcare
- Authorization-to-treat-minors – Please complete to authorize the evaluation and/or treatment of a patient under the age of 18
- Authorization-to-treat-minors-multiple-visits – Please complete to authorize the evaluation and/or treatment of a patient under the age of 18 for multiple future visits
- Appointment of Agent for Minor Child – Please complete to authorize an individual to act as an agent for the care of a minor child
- Living-will-appointment-of-healthcare-surrogate – Please complete and return to Little Traverse Primary Care – no notary needed
Worker’s Compensation Forms
- Employer Work Comp Form – Please complete to authorize us to send your health information to your employer for worker’s compensation purposes
- Worker’s Compensation Authorization Form