Get Started With Us — Patient Forms & Resources
Welcome to Detroit Harmony Health. To make your visit as smooth as possible, we've
made all our essential forms available online. Whether you're a new patient, scheduling
a telehealth appointment, or receiving treatment for chronic or acute care needs,
completing your paperwork in advance helps us provide timely, personalized service.
How It Works
1. Download the form(s) that apply to your visit.
2. Fill them out digitally or by hand.
3. Submit them securely via email , scheduling@detroitharmonyhealth.com and subject line should always Say: Form Completion
Need help? Call us at 313-887-4141 and a staff member will guide you through the process.
2. Fill them out digitally or by hand.
3. Submit them securely via email , scheduling@detroitharmonyhealth.com and subject line should always Say: Form Completion
Need help? Call us at 313-887-4141 and a staff member will guide you through the process.
Available Forms
New Patient Registration Packet
- Demographics
- Insurance Info
- Emergency Contact
- Primary Care History
Consent Forms
Consent to Treat Form
Authorizes us to provide medical evaluation and treatment.
HIPAA Privacy Acknowledgement
Confirms you’ve received our privacy practices and understand your rights.
Telehealth Consent Form
Required for all virtual care appointments.
Financial Policy & Payment Agreement
Details billing policies, copays, insurance handling, and patient responsibilities.
Specialty Forms
Auto Injury Intake Form
Required if you were injured in a motor vehicle accident. Includes insurance, legal, and claim info.
Infusion Therapy Consent
Details risks, benefits, and protocols for infusion services.
CCM & RPM Consent Form
Required for patients participating in Chronic Care or Remote Monitoring programs.
Pain Management Agreement
For patients receiving medication-based pain care.
Medical Record Request
Detroit Harmony Health is committed to protecting your privacy and also to giving you timely, accurate access to your medical records when you need them.
Secure Record Release Form:
Authorization to Release or Obtain Medical Records
Download and print an Authorization form for the Release of information. Email your completed request to records@detroitharmonyhealth.com. You may also fax or mail your request to Detroit Harmony Health.
Charges or fees may apply for requests for medical records.
Questions?
Call us at 313-887-4141 or email Info@DetroitHarmonyHealth.com Our staff is here to assist with any
form or process.
Business Hours
Mon – Fri 09:00 am – 05:00 pm
Sat – Sun Closed
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