Patient Center

Below, pelase find patient forms and information flyers for your use with our practice. Both Dr. Ghassan Atto, M.D. and Dr. Maath J. Alani, M.D. use these forms. 

View Forms list and Descriptions
View List of Medical Insurance Accepted
Map & Directions to our office

New & Existing Patient Forms

New Patient Registration

Two (2) page form for new patients. Please download, print, fill out and bring to your first visit with Dr. Ghassan Atto, M.D or Maath J. Alani, M.D.

Patient Registration Form

Patient Provider Information Agreement

Patient informational flyer regarding “Patient-Centered Medical Care”. Includes hours, services, emergency care information, Doctor and participant agreement as part of this service.

Patient Provider Agreement

Controlled Substance Refill Program

We want to ensure that patients and caregivers have clear communication and safe, effective procedures when patients use opioids.

Patient Agreement Form
1) Agreement to Receive Medicare Chronic Care Management Services Form

2) Controlled Substance Refill Program Patient Agreement Form

3) Medical Record Release Form

4) Medicare Wellness Checkup

5) New Patient Registration Form

6) Patient HIPPA Awareness Form

7) Patient Provider Agreement Form

Medicare Chronic Care Management

An agreement to receive Medicare Chronic Care Management Services. Requires signature. Download, sign and return to Ghassan Atto, M.D.

Patient Services Agreement Form

Medicare Wellness Checkup

Please download and complete this checklist before seeing your Doctor or Nurse. Your responses will help you receive the best health and health care possible.

Medicare Wellness Checkup

Medical Records

Authorization to release confidential health information about me to another physician, person, facility or entity.

Medical Records Release Form

HIPPA Awareness

Patient HIPPA Awareness Form

Medical Insurance Information

Below is a list of medical providers that Dr. Atto, M.D. and Dr. Alani, M.D. accept.

  • Aetna
  • Aetna Better Health
  • BCN
  • BCN Advantage
  • BCBS
  • BCBS Federal
  • Blue Cross Complete
  • Cigna (Hap PPO)
  • Coventry
  • Fidelis (MI Complete)
  • HAP
  • HAP Senior Plus
  • Harbor Health Plan
  • Health Plan of MI (Meridian)
  • Humana
  • Humana Gold Choice
  • Humana Gold Choice PPO
  • Humana PPO Medicare
  • Medicare
  • Medicare Plus Blue
  • Medicaid
  • Meridian Medicaid
  • Molina
  • Molina Medicare
  • Multiplan (PHCS)
  • Priority Health
  • United Healthcare Commercial
  • UMR (Beaumont Health Net)
  • TriWest (Veterans)
  • Railroad Medicare
  • Total Health Care
  • Tri Care

Map & Location