VRA -  Grand Rapids

2505 East Paris Ave. SE           
Suite 100                                           Grand Rapids, MI  49546                 (616) 285-1200

 
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  VRA -  Kalamazoo

1080 North 10th Street                     Suite 100                                           Kalamazoo, MI  49009                       (269) 353-9700

 
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  VRA -  Muskegon

3102 Glade Street                             Muskegon, MI  49444                       (231) 830-1200



patient portal

 
 

New Patient Forms

The links below contain PDF versions of the New Patient Forms that will need to be printed, completed, and brought to your first visit.  Also, please bring your insurance card(s), a picture ID, and a list of your current medications.  

Patient Demographics Form


Medical History Form


Notice of Privacy Practices (HIPAA)


Notice of Privacy Practices (HIPAA)
Patient Acknowledgment Form
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Financial Policy

Financial Policy Acknowledgement Form


Release of Information Forms


Release of information from outside source to VRA


Release of information from VRA to outside source
















 


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