Visitor Forms

Authorization for Disclosure of Health Records

To download the release form, cli​ck here or on the image below:

Consent for a Minor to Receive Treatment

Leaving Town?

You can make sure your child has quick access to medical treatment by signing a Minor Consent Form. If your child needs care while you are away, this form will save valuable time in tracking down a parent/guardian to obtain permission for treatment.

Please know that if your child’s injuries or illness is life-threatening, Eaton Rapids Medical Center may begin treatment prior to your approval.

To download the consent form, click here or on the image below:

Authorization for Proxy Access to Patient Portal

You can use MyERMC to access information for family members and individuals for whom you provide care if given permission by filling out a proxy form.

To download the release form, click here or on the image below:

Patient Financial Support Application

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