VRA -  Grand Rapids

2505 East Paris Ave. SE           
Suite 100                                           Grand Rapids, MI  49546                 (616) 285-1200

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  VRA -  Kalamazoo

1080 North 10th Street                     Suite 100                                           Kalamazoo, MI  49009                       (269) 353-9700

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  VRA -  Muskegon

3102 Glade Street                             Muskegon, MI  49444                       (231) 830-1200

patient portal


New Patient Forms

The links below contain PDF versions of the New Patient Forms that will need to be printed, completed, and brought to your first visit.  Also, please bring your insurance card(s), a picture ID, and a list of your current medications.  

Patient Demographics Form

Medical History Form

Notice of Privacy Practices (HIPAA)

Notice of Privacy Practices (HIPAA)
Patient Acknowledgment Form
Financial Policy

Financial Policy Acknowledgement Form

Release of Information Forms

Release of information from outside source to VRA

Release of information from VRA to outside source


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