New Patient Information

form

Welcome to Catherine’s Health Center! We are so happy that you have chosen us to partner with you in your care. Below you will find our new patient paperwork, as well as information about what to know before your first appointment. If you have any questions about your first appointment or any of our paperwork, please give us a call at (616) 336-8800 and we’d be happy to help.

New Patient Paperwork

New patients have the option of filling out their paperwork in the office or filling it out ahead of time by printing the forms linked below. Simply click the links below, print out and fill out your forms, and have them ready before your first appointment. At this time, we do not have the option to email your forms, instead, we ask that if you’re planning to fill out your forms ahead of time, please bring physical copies into the office for your first appointment.

Medical and Behavioral Health Paperwork

All new medical and behavioral health patients must fill out the following forms:

Patient Registration Form

Billing Policies and Sliding Fee Application

Whole Hearts Survey

Health History Form

Patient Privacy and Consent to Treat Form

Minor Consent Form (if patient is under 18 years of age)

Patients without insurance must also fill out this form:

Patient Insurance Waiver Form 

Dental Paperwork

Please click the link below to download our New Patient Paperwork Packet from our dental offices. Fill out each form to the best of your ability and contact our dental team at (616) 828-0052 if you have any questions.

Dental New Patient Forms 

What to know before your first appointment

What to bring to your first appointment

  • Completed registration forms (above)
  • Photo ID
  • Insurance card and co-pay, if you have insurance
  • Names of medications you are currently taking

If you need financial assistance, please bring one of the following for the most recent year: 

  • 1040 tax form
  • W2 tax form
  • A current pay stub
  • Government assistance statement (such as SSI, disability, unemployment)
  • Letter of support (completed by anyone with whom you live that provides shelter and food)

Insurance Information

If you do not have insurance, we have Health Insurance Navigators who can help you find an affordable option that is right for you, free of charge. For information on which insurance plans we participate in, click this link.

Costs and Financial Assistance

We offer a sliding fee scale based on your income level for any out of pocket costs. Please ask staff for assistance with this application if you have any questions.

Though we are able to offer some services at no cost, other services will require payment. We request payment for services at the time of the office visit. Your provider will discuss any costs with you prior to performing these services. You can find more information about our our costs and financial assistance forms at this link.

After Hours Care

If you are experiencing a medical emergency, call 911 or go to the nearest emergency room. 

If you have an urgent need outside of business hours, please call our office at (616) 336-8800 and leave a detailed message with the best number to reach you. Our on-call provider will quickly return your call.

Cancelling an Appointment

It’s important that you attend your appointments, because your health matters. But, we know life happens. If you need to reschedule an appointment, please call us at (616) 336-8800. If you are unable to make an appointment on time, or at all, please notify us 24 hours before your appointment. You must attend your first appointment for us to establish care with you as a patient.

Missed appointments means missed opportunities to provide care for patients who need a visit. To make sure that everyone can access the care they need, you are only able to miss four appointments per year before we ask that you find care elsewhere. Please ask our staff if you have more questions regarding this policy.

Translate »