Forms

Please print these forms and prepare them
for your new patient appointment.

Fax to 231-935-3548 or mail to:

Mary R. Clifton, MD
800 Cottageview, Ste 1080-B
Traverse City, MI 49684

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

Insurance Information