HAROLD F. ROTH, D.O.
HAROLD F. ROTH, D.O.

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.

More

Forms for All AFC Facilities -- to be faxed to (517)908-8005 prior to patient being seen

AFC Patient Information Intake Form
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]
Adult History Form
ADULT HX FORM.pdf
Adobe Acrobat document [85.7 KB]
Insurance Authorization and Assignment of Benefits
INSURANCE AUTHORIZATION AND ASSIGNMENT O[...]
Adobe Acrobat document [200.1 KB]

Fairview AFC

FAIRVIEW AFC Consent for Treatment Form
Consent Treatment Fairview AFC 102314.pd[...]
Adobe Acrobat document [85.5 KB]

Prestige Pines AFC

PRESTIGE PINES AFC Consent for Treatment Form
Consent Treatment Prestige Pines 102314.[...]
Adobe Acrobat document [85.5 KB]

Prestige Way AFC

PRESTIGE WAY AFC Consent for Treatment Form
Consent Treatment Prestige Way 102314.pd[...]
Adobe Acrobat document [85.5 KB]

Timber Ridge AFC

TIMBER RIDGE AFC Consent for Treatment Form
Consent Treatment Timber Ridge 102314.pd[...]
Adobe Acrobat document [85.5 KB]
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