Contact and Appointments
HAROLD F. ROTH, D.O.
1627 Lake Lansing Road
Suite 200
Lansing, MI 48912-3788
Phone
(517) 485-1789
Fax
(517)485-2357
Business Hours
Monday - Friday: 8:00am-4:00pm Closed Daily from Noon to 2:00pm
New Online Presence
Explore our new website to find out everything about our practice.
Patient Information
Everything you need to know about your visit to the doctor.
Forms for All AFC Facilities -- to be faxed to (517)485-2357 prior to patient being seen
AFC Patient Information Intake Form
PATIENT INFORMATION INTAKE FORM FOR AFC [...]
Adobe Acrobat document [249.1 KB]
PATIENT INFORMATION INTAKE FORM FOR AFC [...]
Adobe Acrobat document [249.1 KB]
Current List of Medications Form
medication intake form upon admissions-1[...]
Adobe Acrobat document [145.4 KB]
medication intake form upon admissions-1[...]
Adobe Acrobat document [145.4 KB]
Insurance Authorization and Assignment of Benefits
INSURANCE AUTHORIZATION AND ASSIGNMENT O[...]
Adobe Acrobat document [200.1 KB]
INSURANCE AUTHORIZATION AND ASSIGNMENT O[...]
Adobe Acrobat document [200.1 KB]
Fairview AFC
FAIRVIEW AFC Consent for Treatment Form
Consent Treatment Fairview AFC 081617.pd[...]
Adobe Acrobat document [88.4 KB]
Consent Treatment Fairview AFC 081617.pd[...]
Adobe Acrobat document [88.4 KB]
Prestige Pines AFC
PRESTIGE PINES AFC Consent for Treatment Form
Consent Treatment Prestige Pines 081617.[...]
Adobe Acrobat document [88.3 KB]
Consent Treatment Prestige Pines 081617.[...]
Adobe Acrobat document [88.3 KB]
Prestige Way AFC
PRESTIGE WAY AFC Consent for Treatment Form
Consent Treatment Prestige Way 081617.pd[...]
Adobe Acrobat document [88.3 KB]
Consent Treatment Prestige Way 081617.pd[...]
Adobe Acrobat document [88.3 KB]
Timber Ridge AFC
TIMBER RIDGE AFC Consent for Treatment Form
Consent Treatment Timber Ridge 081617.pd[...]
Adobe Acrobat document [89.3 KB]
Consent Treatment Timber Ridge 081617.pd[...]
Adobe Acrobat document [89.3 KB]
Print 