Forms requiring completion
You are expected to complete and submit the following forms:
- Notice of Privacy Brochure (PDF) — This notice describes how medical information about you may be used and shared, and how you can have access to this information.
- Patient Intake Form (PDF) — For new patients.
- OPHS services are available to all Oakland County residents and surrounding areas, regardless of their financial or insurance status.
- Uninsured patients may apply for OPHS’ Family Assistance Plan (FAP), which affords many patients a discount on their office visit. (Lab work and procedures are already discounted.)
- To apply for the FAP, patients need to present proof of their household income and number of household members.
- Discounts will be afforded based on patients’ level of poverty, which is determined by federal guidelines.
- Navigation services to sign up patients without health coverage or people who qualify for the Marketplace.
- Medicaid, Medicare, major health plans and private healthcare coverage are accepted. For instance: Blue Cross Blue Shield, The Wellness Plan and Great Lakes Health Plan.