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Sandra L. Staublin, MD

Jeffrey B. Hoogstra, MD

Belinda Chou, MD

Jennifer Perry, MD

Derrick Holeman, MD

Tracie Medrano-Smith, DO

Shannon Leikert, DO

Marielle VanderVennen, MD

Online Bill Pay

FORMS

All forms are in PDF format. Please click on the form and download it to your device.

Patient Information Sheet

Please complete this form and bring it with you to your first visit.

Medical Authorization Release Form

This form is required for the release of medical records.

MIHS Athletic Sports Form

18 Month / 24 Month Questionnaire

Please complete prior to your child's appointment.

30 Month Questionnaire

Please complete prior to your child's appointment.

Follow My Health - Notification Preferences

Instructions on how to change how we notify you of appointments.

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