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IMPCP

Internal Medicine Primary Care Physicians

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    • Varsha Revankar, M.D.
    • Timothy Lamb, M.D.
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IMPCP > Forms

Forms

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    • Forms to bring to visits
    • Informational Forms for visits
  • Handouts
    • Helpful Handouts

Forms

Dr. Lamb New Patient Form

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Dr. Revankar New Patient Form

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Privacy Practice Receipt of Acknowledgement

Forms to bring to visits

Patient Verification Form

Forms to bring to visits

Advanced Notice of Non-Coverage Medicare

Forms to bring to visits

Advanced Beneficiary Notice of No Coverage (ABN)

Forms to bring to visits

Advanced Patient Questionnaire

Forms to bring to visits

Contact

Have a question? call us now

248 253 1468

Fax

248 253 1472

Need support? Drop us an email

Office Manager

We are located at

42557 Woodward, Suite 110
Bloomfield Hills, MI 48304

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Instructions on

Medication/Labs

Bill Payment

Billing Questions? Drop us an email

Billing Questions

Office Hours

The office can be reached

Monday-Thurs:
8:00 am - 4:00 pm
Lunch: 12:00 pm - 1:00 pm
Fri: 8:00 am - 12:00 pm

After Hours

After Hours Answering Service

248-965-7547

MedPost Urgent Care of Bloomfield Township

248-451-0933

Bloomfield Urgent Medical Center

248-333-0333

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