Autofax form - Detroit Medical Center - dmc 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Physician’s Full Name in the designated field at the top of the form.
3. Fill in your Office Address, including City & Zip Code, ensuring all details are accurate for effective communication.
4. Provide your Office Phone Number and Office Fax Number to facilitate easy contact and document transmission.
5. Identify an Office Contact Person who will be responsible for receiving faxed documents.
6. Select the types of documents you wish to receive by checking the appropriate boxes, such as Admit Notice or Radiology Reports.
7. If you prefer not to receive any documents via Auto Fax, check the corresponding box provided.
8. Sign and date the form at the bottom to indicate your agreement and desire to enroll in the program.
9. Finally, submit your completed application by faxing, emailing, or mailing it to Health Information Management as specified.

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