Forms
These are our forms available for you to download. They are in PDF format and require Adobe Acrobat Reader, which you can download here for free.
Record Request Form
- Online Record Request Form
- PDF Format - Print and Fax
Copy Request Form
- PDF Format - Print and Fax
Authorizations
Authorizations in RED require an ORIGINAL signature to release records. Please mail completed authorizations to Minute Man Services.
- General Court Authorization
- Authorization for Release of Medical / Employment Information
- Authorization for Release of Pharmacy Records
- Authorization for Release of Insurance Information
- Authorization for Release of Educational Records
- Authorization for Release of Financial Institution Records
- Authorization for Release of Psychological Records
- Authorization for Release of Social Service Information
- Authorization for Release of Worker's Compensation Records
- American National Insurance
- Blue Care Network of Michigan
- Care Choices HMO
- CAREMARK *
- Community Emergency Medical Service
- Counseling Associates, Inc
- DEPARTMENT OF VETERANS AFFAIRS *
- DETROIT FIRE DEPARTMENT - EMS DIVISION *
- Detroit Medical Center (DMC)
- H&R Block
- Health Source Saginaw
- Heartland Health Care Center
- Henry Ford Health Systems - Psychotherapy
- Humana
- IRS *
- Livingston County EMS
- Macomb County Medical Examiner
- Mayo Clinic
- MICHIGAN DEPARTMENT OF COMMUNITY HEALTH (MDCH) *
- MEDICARE PART A *
- MEDICARE PART B *
- Mercy Hospital - Port Huron
- Michigan Head Pain & Neurological Institute
- MICHIGAN INCOME TAX *
- MILITARY MEDICAL RECORDS *
- Oakland Family Services
- Omnicare Health Plan (OCHP)
- Pioneer Counseling Center
- Pontiac Osteopathic Hospital (POH)
- QUEST DIAGNOSTICS *
- Select Specialty Hospital
- SOCIAL SECURITY ADMINISTRATION * - Typeable!
- SOCIAL SECURITY DIVISION OF EARNINGS *
- St. John Eastwood Clinics
- St. John Hospital - Brighton
- St. Joseph Mercy Ann Arbor/Livingston
- St. Joseph Mercy Behavioral Services
- Unemployment Insurance Agency - TYPEABLE!
