For Patients at Grand River Medical Group

Patient Forms

Before your appointment with us, quickly and conveniently access patient forms from our practice.

download Adobe ReaderTo view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.

Medicare Exam

Welcome to Medicare exam: There are five forms.

  1. Initial Preventive Physical Exam (IPPE) Explanatory Letter - Before you schedule your Initial Preventative Physical Exam.
  2. IPPE Explanatory Letter - After you schedule your Initial Preventive Physical Exam.
  3. Depression Screening questionnaire
  4. Safety Screening questionnaire

Annual Wellness Visit

This exam is available AFTER you had Medicare for at least 1 year

  1. Initial Annual Wellness Visit Explanatory Letter - Initial Annual Wellness Letter
  2. Health Risk Assessment
  3. Subsequent Annual Wellness Visit Explanatory Letter - Subsequent Annual Wellness Letter
  4. Health Risk Assessment
  5. Provider/Supplier List for Initial Annual Visit
  6. Provider/Supplier List for Subsequent Annual Wellness Visit