Patient Forms
Below are links to our most used patient forms. Feel free to download these forms to complete prior to your appointment.
If the form is needed more than one time, the frequency is noted in the form description.
If you have any questions, give us a call at the office.
Medical History Form for New Patients
This form is only used one time and must be returned prior to scheduling your first appointment. The methods of return are listed on top of the first page of the form.
Please complete this form in its entirety.
Family history is critical in medical decision making in Pediatric Endocrinology.
This form is to be completed by new patients only.
Diabetes Follow-up Form
This form is used only by our Type 1 Diabetes patients, and should be completed before each visit. Bring the completed form to the office on the day of your visit.
You may download this form in MS Word, or Adobe PDF. The PDF is not a fillable form, but can be completed with a stylus on a touch-screen.
New Patient Registration Form
This form is only used one time.
We use this form to collect information for new and transfer patients only. If you are an existing patient, you will not need to complete this form. If you are a new patient, please navigate to the New Patients page. You will also find a link to this form there.
Patients transferring care
If you have previously seen Dr. Wood at one of his other offices (Ann Arbor, Grand Rapids, or Marquette), and you would like to be seen in our Ypsilanti office, we need to register you in our EMR system and schedule an appointment for your here.
The form links to the left are those you will need to complete prior to your initial visit at the Livonia office.
We will need the New Patient Form completed prior to scheduling your first appointment. (Or you can call us, and we'll complete it over the phone for you.)
If your first visit is in-person, you may bring the remainder of these forms with you. If your first visit is virtual, we will need them completed and returned ahead of the appointment.
You may send them via email, fax, or by attaching to a patient portal message.
Medical Records
If you need your medical records sent outside of our practice, we need your written permission to do so.
Please download this form in its entirety, sign it, and return to our office. If the patient is 13 years of age or older, he or she must also sign the release.
You can email it to info@mipeds.org, fax it to (734) 744-4471, or upload it to the patient portal.