Submit Forms / Medical Records
We are on the Beaumont electronic medical records system so you do not need to upload any lab/imaging results that were performed at Beaumont. We encourage you to upload any forms and previous medical records ahead of your visit so your clinician can review it before your visit.
Patient Name
*
First Name
Last Name
Patient Date of Birth
*
/
Month
/
Day
Year
Date
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Select and Attach Files to Upload
*
AE New Patient Forms / Questionnaire
Home Blood Sugar logs or Pump/CGM uploads
Lab Results
Imaging Results
Medical Records/Office notes another Endocrinologist
Medical Records/Office notes from another provider
Other
*
Browse Files
Cancel
of
Submit
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