3665 E. 11 Mile Road . Warren, MI 48092 - Get Directions

Schedule Consultation . 586-573-0438

Michigan Head & Neck Institute

Download Patient Forms

Michigan Head & Neck Institute understands that our patients want to have their office visit be as smooth as possible. To help this process, we have provided our patient forms online for you to download and complete before your visit.

Please complete the forms below, and simply bring them to your first appointment with you as they will assist in a proper diagnosis. Filling them out ahead of time will speed up the paperwork process on the day of your visit. Please print clearly.

IF YOU DO NOT HAVE THE PAPERWORK FILLED OUT PRIOR TO YOUR APPOINTMENT, PLEASE ARRIVE 30 MINUTES EARLY TO ALLOW TIME TO COMPLETE THE FORMS, OTHERWISE YOU MAY BE ASKED TO RESCHEDULE YOUR APPOINTMENT.

CELL PHONES ARE NOT ALLOWED IN OUR TREATMENT AREA. If a cell phone goes off, it may cause interference with some of our devices and can cause a shock to our patients while they are in treatment. If you do not want to leave your cell phone at home, in your car, or with someone else during your appointment, we can hold the cell phone at our reception area.

All patients are required to complete our Patient Information Form (Click Here to Download).

If your treatment is related to an accident and/or injury – you will need to complete our Accident Addendum Form (Click Here to Download) IN ADDITION TO our Patient Information Form.

Note: You will need Adobe Acrobat Reader to view these forms. Click here to download a free version of Acrobat Reader.

Schedule a Consultation (586) - 573 - 0438


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The contents of this website, such as text, graphics, images, and other materials are for informational purposes only. While there are many commonalities among multiple TMD and sleep apnea cases, each patient is unique. Information on this website should be used to educate the reader about what they should discuss with their doctor if they are suffering from the listed symptoms. The information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of your physician or you may call our office with any questions you may have regarding TMD or sleep apnea. If you think you may have a medical emergency, call your doctor or 911 immediately.