Patient Forms

Allergy & Asthma Questionnaire
Pediatric Health History
Adult Health History
Dr. Rourke’s Sinus Questionnaire and Health History
Dr. Rubin’s Voice Questionnaire

*Please email completed forms to preferred location:

  1. St. Clair Shores – stclairshores@lakeshoreent.com
  2. Macomb/Facial Plastic Surgery – macomb@lakeshoreent.com
  3. Grosse Pointe – grossepointe@lakeshoreent.com
  4. Rochester – rochester@lakeshoreent.com
  5. Sterling Heights – sterlingheights@lakeshoreent.com

Sub-Specialty Care in Your Backyard

Six Convenient Locations

Visit Our St. Clair Shores Office

st. clair shores

21000 Twelve Mile Road
Suite 111
St. Clair Shores, MI 48081

586-779-7610

Visit St. Clair Shores

Visit Our Macomb Township Office

macomb township

17900 23 Mile Road
Suite 203
Macomb Township, MI 48044

586-263-7400

Visit Macomb Township

Visit Our Rochester Hills Office

rochester hills

1202 Walton Boulevard
Suite 201
Rochester Hills, MI 48307

248-652-0044

Visit Rochester Hills

Visit Our Grosse Pointe Office

Grosse Pointe

17770 Mack Avenue
Grosse Pointe, MI 48230
‍

313-885-6367

Visit Grosse Pointe

Visit Our Sterling Heights Office

Sterling Heights

11080 Hall Road
Suite A
Sterling Heights, MI 48314

586-254-7200

Visit Sterling Heights

Visit Our Warren Office

Warren

11900 E. 12 Mile Road
Suite 210
Warren, MI 48093

586-582-7100

Visit Warren

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