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Sports Medicine Patient Registration Form

Sports Medicine Patient Registration Form for McLaren Greater Lansing

McLaren-Greater Lansing Sports Medicine Patient Registration Form
This is a secure site.  Please complete the information below.

* Indicates required information





 

 



 

 








 






 












 

 

 

 

 



 


 



 


 


 

   
These next 10 questions are insurance information
 



 







 







 

 

   
The information below will assist us in your care and in any communications with you,
while protecting your confidentiality. Please review and check 'Yes' or fill in a name
if approved. You may amend this statement at any time. 




 


 



   
If you are a Medicare Recipient, please answer the rest of the questions.
They are required by Medicare: