Forms & Authorizations

These are our forms available for you to download.
They are in PDF format and require Adobe Acrobat Reader, which you can download here for free.

Record Request Form

Copy Request Form

PDF Format - Print and Fax

Authorizations

Please mail completed authorizations to Minute Man Services.

General Authorizations:

Our Most Popular Facilities

Description Original Signature Notarization Required Download Link
AFLAC     Download Now
BCBS of Michigan (Member)     Download Now
BCBS of Michigan (Representative)     Download Now
Detroit Fire Department EMS Yes Yes Download Now
Henry Ford Heath System     Download Now
Kroger Pharmacy     Download Now
Life EMS   Yes Download Now
Livingston County EMS   Yes Download Now
Mayo Clinic     Download Now
Medicare Part A & B     Download Now
Michigan Department of Community Health (MDCH) Yes   Download Now
Michigan Department of Treasury Yes   Download Now
Mobile Medical Response Yes   Download Now
Molina Healthcare     Download Now
Redford Twp. Fire Dept-EMS   Yes Download Now
Social Security Administration Yes   Download Now
Social Security Administration (Div. of Earnings) Yes   Download Now
Traverse City Fire EMS Dept   Yes Download Now
U of M Hospital   Yes Download Now
US Dept of Treasury (Form 4506 IRS Tax Return) No   Download Now
VA Hospital - Dept. of Veterans Affairs     Download Now
Walmart     Download Now

Not seeing the auth you need? Contact Us