Welcome to Academic Heart & Vascular. We are pleased that you have chosen us to serve your medical needs.
For your convenience, we have provided a "Patient History Form" in Adobe PDF file format. Please print and complete this form, and bring it with you on your first visit. There is also an "Authorization to Release Records Form" to use when you want us to send your medical records to a third party. This form must be printed and sent or brought in to the office.

If you have any questions about the forms or any other information you may need to bring to your appointment, you may call our office for assistance at (248) 898-4163.

Patient Forms

Patient History Form
The Patient History Form should be completed prior to your first visit.

Authorization Form
If you would like records sent to a third party, please print out and complete this form and send in to our office.

Notice of Privacy Policies
This Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information.

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