Please print these forms and prepare them
for your new patient appointment.
We will contact you to schedule an appointment after we receive your forms.
Failure to keep your new patient appointment will result in an $80.00 charge.
Confidential Request for Information
Fax to 231-935-3548 or mail to:
Mary R. Clifton, MD
800 Cottageview, Ste 1080-B
Traverse City, MI 49684
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