COS Clinton Township
21550 Harrington, Suite A
Clinton Township, MI 48036

Patient Forms and Insurance Information

Save time by filling out the appropriate form(s) either online or print them out and bring them to your appointment!

Forms require that you have Adobe Reader installed on your computer (most computers have this already installed). You can get it here FREE from Adobe Not sure if you have Adobe Reader? Just click on one of the forms if you have it installed it will open if not it will prompt you to get it.

  1. Adult New Patient Registration Packet
  2. Minors New Patient Registration Packet
  3. Patient Regsitration Packet For Workmans Comp
  4. Injury / Accident / or Workmen's Compensation Form
  5. Knee History Work Sheet
  6. Shoulder History Worksheet
  7. HIPAA Privacy Policy

Billing and

Financial Policy and Insurance Information

We participate with most insurances. Bring your insurance card and any necessary referral forms with you to your appointment. If this is not completed you may not be seen. If you are not covered or have copayments, we require payment at the time of service. For your convenience, you may pay by cash, Visa, MasterCard of personal check. If your medical bill creates a difficulty for you, please speak to our office biller about developing a payment plan.

Managed Care and HMO

Any Manage Care or HMO including Managed Care Medicaid require prior approval from the primary care physician. All referral forms must be available at the time of the visit. To insure this, please bring the form with you. You cannot be seen without a referral form.

Auto Accidents Liability & Worker’s Compensation

If your medical care is to be covered by Worker’s Compensation, liability insurance or automobile insurance, written authorization for payment and/or the proper claim number must be obtained and brought with you at the time of your appointment in this office. Payment of bills is the responsibility of the individual who has received the treatment.

There will be a fee for the completion of any insurance form having to do with mortgage payments, loans, etc. while you are disabled. Employer disability forms will be done at no charge.


Most prescriptions can be refilled over the phone. If you are calling to have a prescription refilled, please have ready the name of your medication, the date filled, the prescription number and your pharmacist’s telephone number. You should call at least 24 hrs in advance of running out of your medication. Notify us before 3 P.M. that you need your prescription refilled. Some prescriptions such as pain medication and narcotics may not be refilled after 3 P.M. Exceptions may be made for drug reactions and day of surgery.