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  • (616) 738-0737

  • Home
  • About
    • About Lakeshore Internal Medicine
    • Meet Our Providers
  • Policies
    • HIPAA Policy
    • Visit Policies
    • Medication Policies
    • Vaccine Policy
    • Other Policies
  • Services
  • Resources
    • Pediatric Milestones
    • Care Management
    • Forms
  • Preventative Care
  • Contact Us
Access Patient Portal
Pay Your Bill
Visit Us
  • (616) 738-0737

Visit Us
Access Patient Portal
Pay Your Bill

Patient Forms and Resources

New Patient Forms

  • Patient Information Sheet
  • Insurance Form
  • HIPAA Form for Minor
  • HIPAA Form for Adult
  • Priority Health PCP Change Form
  • BCBS PCP Change Form
  • Patient Portal Information
  • PCMH Education

Other Forms

  • Sports Physicals
  • Health Appraisals
  • Medical Records Release to LIMPA
  • Medical Records Release from LIMPA
Lakeshore Internal Medicine and Pediatric Associates logo.
  • 437 North 120th Avenue
    Holland, Michigan 49424

  • (616) 738-0737

  • (616) 738-0575

  • Business Hours

    Mon:8:00 AM to 12:00 PM
    1:00 PM to 6:00 PM
    Tue:7:00 AM to 12:00 PM
    12:30 PM to 5:00 PM
    Wed:8:00 AM to 12:00 PM
    1:00 PM to 5:00 PM
    Thu:7:00 AM to 12:00 PM
    1:00 PM to 5:00 PM
    Fri:8:00 AM to 12:00 PM
    12:30 PM to 3:00 PM

    Sat & Sun: Closed
    On-call providers available for after-hour calls.

  • Phone Hours

    Mon -Thu:8:30 AM to11:45 AM
    1:15 PM to 4:30 PM
    Fri:8:00 AM to 11:45 AM
    12:30 PM to 2:30 PM
    Sat & Sun:Closed

     

  • Home
  • About Us
  • Meet Our Providers
  • HIPAA Policy
  • Visit Policies
  • Medication Policies
  • Vaccine Policy
  • Other Policies
  • Services
  • Pediatric Milestones
  • Care Management
  • Forms
  • Preventative Care
  • Contact Us
  • Home
  • About Us
  • Meet Our Providers
  • HIPAA Policy
  • Visit Policies
  • Medication Policies
  • Vaccine Policy
  • Other Policies
  • Services
  • Pediatric Milestones
  • Care Management
  • Forms
  • Preventative Care
  • Contact Us
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