Forms

Troy Internal Medicine Forms

Please click the link below to download our new patient packet.

New Patient Packet

Please click the link below to download our Complete Physical Exam packet.

CPE Packet

Please click the link below to download our Medicare Wellness forms.

Medicare Wellness Form

Please click the link below to fill out our Medicare Wellness Visit form online.

Medicare Wellness Online Form

Please click the link below to download our controlled substance agreement.

Controlled Substance Agreement

Please click the link below to download our records release form.

Records Release Form

Please click the link below to download our HIPAA form.

HIPAA

Please click the link below to download our Advance Directive form.

Advance Directive

Please click the link below to download our Travel Health New Patient form.

Travel Health New Patient Form

DOT Physical Exam Form

Please click the link below, which will take you to the Federal Motor Carrier Safety Administration website DOT Physical Exam Form.  Please print, fill out as directed, and bring the form to your DOT Physical appointment.

DOT Physical Exam Form

Tree of Life Forms

Please select your Tree of Life therapist below to access their patient intake forms.

Forms for Brian Maskill MA, LLPC: Monday and Tuesday

brian@treeoflifecounselingservices.com

Forms for Jessica Contreas-Janette MA, LLPC: Wednesday and Thursday

jessica@treeoflifecounselingservices.com

Tree of life accepts the following insurances:

• ASR Health
• Blue Cross Blue Shield
• Blue Care network
• HAP (PPO only)
• Mclaren Health Plan
• Medicare
• United Health Care

Billing questions for counseling services will be directed to Tree of Life: 248-608-4514

Tree of Life will see patients at both offices listed on their service contract form.