Patient Forms:
Save time when you get to the doctor's office by downloading all the forms that you need from home. Just fill out the forms (in black ink only, please) and bring them with you to the office.
Please note - You will need to have Adobe Reader loaded on your computer to read and print the forms. You can download a free copy HERE.
The following form is a copy of our Privacy Practices. You can download it and keep it for your records.
Disability/ FMLA Forms:
If you need disability / FMLA forms filled out for any time off from work due to pregnancy or surgery - please make sure you fill out all of your paperwork in the sections marked 'Employee' and sign all employee signature areas before bringing them to the office. In addition to the forms provided by your employer, you will also need to print and fill out our Disability Forms Request.
Please allow up to 7 business days for forms to be completed and there is a $15 form fee (per set of forms) that will need to be paid before the forms are picked up. If you need them faxed back - the fee is $17.
You can fax your forms to the office at (248) 948-6904, email to bwcsurgery@betterwomenscare.com or simply drop them off during normal business hours.
If you have any questions, feel free to call Jodi - (248) 948-6900 ext. 130.
If you need disability / FMLA forms filled out for any time off from work due to pregnancy or surgery - please make sure you fill out all of your paperwork in the sections marked 'Employee' and sign all employee signature areas before bringing them to the office. In addition to the forms provided by your employer, you will also need to print and fill out our Disability Forms Request.
Please allow up to 7 business days for forms to be completed and there is a $15 form fee (per set of forms) that will need to be paid before the forms are picked up. If you need them faxed back - the fee is $17.
You can fax your forms to the office at (248) 948-6904, email to bwcsurgery@betterwomenscare.com or simply drop them off during normal business hours.
If you have any questions, feel free to call Jodi - (248) 948-6900 ext. 130.
Request for Medical Records/Release of Information:
For questions regarding Medical Records, please call (248) 948-6900 ext. 103
Our office will now process your request for medical records. The State of Michigan has become a regulated state for the pricing of copying medical records and the following rates went into effect February 04, 2016. Unless records are picked up in person, all records will be sent via fax only. The faxing fees are listed below.
Copies for Patients
There will be a charge to patients who request copies of their medical records for their own use. The charge for this service will be:
$1.17 per page for pages 1-20
$.58 per page for pages 21-50
$.23 per page for pages 51+
All fees must be paid prior to receiving records
Copies for Attorney and Insurance
There will be a charge for copies of medical records, when patients authorize release of such information to insurance companies, attorney/law offices, etc. All records are faxed back only.
Charges will be:
$23.34 base fee plus:
$1.17 per page for pages 1-20
$.58 per page for pages 21-50
$.23 per page for pages 51+
Patients will NOT be responsible for these charges. The requestors will receive an invoice from Better Women’s Care. All fees must be paid before records are faxed.
Fax Fees are as follows (and in addition to the fees set above):
Pages 1-25= $5, Pages 25-50= $8, Pages 50-75 = $11, Pages 75-100 = $14
For more information please feel free to call the office during regular business hours.
Request for Medical Records/Release of Information:
For questions regarding Medical Records, please call (248) 948-6900 ext. 103
Our office will now process your request for medical records. The State of Michigan has become a regulated state for the pricing of copying medical records and the following rates went into effect February 04, 2016. Unless records are picked up in person, all records will be sent via fax only. The faxing fees are listed below.
Copies for Patients
There will be a charge to patients who request copies of their medical records for their own use. The charge for this service will be:
$1.17 per page for pages 1-20
$.58 per page for pages 21-50
$.23 per page for pages 51+
All fees must be paid prior to receiving records
Copies for Attorney and Insurance
There will be a charge for copies of medical records, when patients authorize release of such information to insurance companies, attorney/law offices, etc. All records are faxed back only.
Charges will be:
$23.34 base fee plus:
$1.17 per page for pages 1-20
$.58 per page for pages 21-50
$.23 per page for pages 51+
Patients will NOT be responsible for these charges. The requestors will receive an invoice from Better Women’s Care. All fees must be paid before records are faxed.
Fax Fees are as follows (and in addition to the fees set above):
Pages 1-25= $5, Pages 25-50= $8, Pages 50-75 = $11, Pages 75-100 = $14
For more information please feel free to call the office during regular business hours.
Authorization to Release Medical Records to another Doctor/Facility - Please be sure to print the doctors name, address and phone number that you are requesting the records from.
Authorization to Release Medical Records to Better Women's Care - Please be sure to print the doctors name, address and phone number that you are requesting the records from. Please check with that office about any fees that may be incurred for processing record requests.
You can fax your forms to the office at (248) 948-6904, email them to bwc@betterwomenscare.com or simply drop them off during normal business hours.
You can fax your forms to the office at (248) 948-6904, email them to bwc@betterwomenscare.com or simply drop them off during normal business hours.
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