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DMC Children's Hospital of Michigan 56th Annual Clinic Days REGISTRATION FORM Preregistration for all Clinic Days events is REQUIRED by October 4, 2013. Please complete and return this form to the

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1. Start by gathering all the necessary information for the form, such as the child's personal details, medical history, and any supporting documents or referrals.
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3. Begin by filling out the child's personal information, including their full name, date of birth, gender, and contact details.
4. Provide any relevant medical history information, including previous diagnoses, surgeries, allergies, and current medications.
5. If required, provide details about the referring physician or agency, including their name, contact information, and any relevant identification numbers.
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8. If necessary, attach any supporting documents, such as medical records, referrals, or consent forms, as instructed.
9. Review the completed form one last time for accuracy and completeness before submitting it.

Who needs DMC Children's Hospital of:

1. Children who require specialized medical care, treatment, or procedures.
2. Parents or guardians seeking comprehensive healthcare services for their children.
3. Pediatricians or primary care physicians referring their young patients for specialized care or consultations.

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