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Wayne State University Physical Medicine in Dearborn

Below are the forms you will need for your visit. Please print all five forms and bring them to your appointment. To view the documents, Adobe Acrobat Reader is required.
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Acknowedgment of Receipt of Notice of Privacy Practices Form (Download PDF) 

Financial Policy (Download PDF)  

General Consent Form (Download PDF)  

Notice of Privacy Practices Form (Download PDF)  

Patient Registration Form (Download PDF)  



 

University Physician Group PM&R Oakwood

8:30 am – 5 pm Monday-Friday

18100 Oakwood Blvd Suite 300
Dearborn, MI 48124

Phone: 313-429-7977

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