Online Forms

To request Health Information Records, please complete and submit the applicable form.

To authorize health information to be sent to GLOC:
Health Information Release Form

To authorize health information from GLOC:
GLOC Patient Health Information Release Form

Medical History 1
View Medical History 1 Form

Medical History 2
View Medical History 2 Form

Dr. Reichard Foot/Ankle
View Foot/Ankle Form

Testimonials

  • Dr Peters was Awesome with My Mom’s Hip Surgery

    “Dr Peters was awesome with my mom's hip surgery. his entire staff was so caring and patient thru this whole thing for her. She was very nervous as she had never had surgery before and they were so good with her. My family would recommend Dr Peters hands down to anyone needing surgery. The kindness […]
  • Amazing Results after Shoulder Surgery on Both Shoulders

    “Dr. John Reineck came into my life after a head-on auto accident shattered both of my shoulders. On the strong recommendation from medical professionals, I waited in Munson Hospital for Dr. Reineck. Replacing two shoulders at once is somewhat unusual and my family wanted only the best. That’s exactly what I got! His surgical experience […]
  • GLOC has a Caring, Helpful Approach

    “I can’t speak highly enough of Great Lakes Orthopaedic Center. I have physical therapy for my knee and back. My experience with Josh has been top-notch. He not only knows therapy, but he knows a lot medically and that makes a big difference. I have also been working with Lynne for my back and she […]

Grey Spine Icon

800.203.0044

Office Hours:
Mon - Fri, 8am - 5pm