A. Timothy Linehan, M.D.
Board Certified
Adult & Pediatric Allergy & Immunology

Pre-Registration

If you have scheduled an appointment to be evaluated at Northern Michigan Allergy & Asthma Center, our receptionist may have directed you to this website to complete new patient medical forms. Our goal is to eliminate any unnecessary wait time prior to your scheduled appointment. Please print out the following document, read and follow all instructions, fill out appropriate pages and bring them with you to your initial appointment.

Registration Forms

These forms are in Adobe Acrobat Reader format. If you are unable to open these forms, you need to download Acrobat Acrobat Reader here.

Medical Record Release Form

The Michigan Medical Record Act permits providers to charge a fee for preparation of a copy of medical record information prior to making a disclosure.  These costs include the cost of supplies and labor used in producing the copy, postage and preparation of a summary report of information disclosed.  All requests for release of records must be received in writing with a minimum of one week’s advance notice.  Older records may be stored off site and may require a more lengthy retrieval period.  Records released will be mailed to the designated recipient or can be picked up in person with proper identification by the requesting legal party.  All associated record release fees must be paid in full prior to release of copies.  Please contact our office at 231-487-6575 to determine the associated fee for your request.  You may return the form by mail or by fax to 231-439-9837.  Records will be released in accordance with Michigan State law.

Click here to download the Medical Record Release Form!

These forms are in Adobe Acrobat Reader format. If you are unable to open these forms, you need to download Acrobat Acrobat Reader here.