Patient Forms

Endocrine Kids looks forward to having you join our practice. For an appointment, you may call us at (248) 347-3344 or request one online.

Once you have made your initial appointment, you can pre-register by completing our interactive registration and health history form.

If you choose to download and print out these forms instead, you may do so from the forms listed below and fax them to us at (248) 305-6845 or bring them with you to your initial appointment.

New Patient Forms

Interactive:

• New Patient Registration
• Health History

Downloadable:

• New Patient Registration
• Health History

The additional forms below will be provided at your appointment, but you may download them to review ahead of time.

Additional Patient Forms

• HIPAA Privacy Policy
• Release of Medical Records
• Office Policies
• Patient/Provider Agreement

Diabetes Forms for Established Patients

For patients on multiple daily injections

• Blood Sugar Record Form
• School Order Form
• Ketone and Sick Day Guidelines

For patients on an insulin pump

• Blood Sugar Record Form
• School Order Form
• Ketone and Sick Day Guidelines

Basal Assessment Forms

• Basal Assessment - Overnight
• Basal Assessment - Morning
• Basal Assessment - Afternoon
• Basal Assessment - Evening

On a yearly basis, your child's school will require diabetes school order forms. We recommend that you provide them with both the school order form and the sick day guidelines. The school order form will require Dr. Bishop's signature.

Please note: It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat Reader for free by clicking on the icon below.