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ANCILLARY SERVICES OWNERSHIP DISCLOSURE STATEMENT

Dear Patient,

This notice is to inform you that Michigan Head & Spine Institute physicians have a financial interest in ancillary services such as Outpatient Interventional Procedure Rooms for outpatient procedures such as interventional pain injections, kyphoplasty, etc , MRI, CT, X-ray and Physical Therapy, and DME equipment (neck and spine braces). You as a patient may choose to have your procedure performed by the entities owned by a Michigan Head & Spine Physician but you should know that you have the right to seek care at any facility that offers these services. Facilities in the area that provide these services include but are not limited to the following:

Hospitals:

Beaumont Health
- Royal Oak, Troy, Dearborn, Grosse Pte., Wayne, MI

Detroit Medical Center Hospitals
- Detroit, Commerce Twp., MI

Henry Ford Health Systems
- Detroit, West Bloomfield, Macomb Twp., MI

McLaren Health Care
- Macomb, Oakland, Lapeer, Clarkston, MI

Ascension

St. John-Providence
- Southfield, Novi, MI

Crittenton
- Rochester, MI

St. Joseph Health
- Pontiac, MI

St. Mary Mercy
- Livonia, MI

Freestanding Outpatient Diagnostic Testing Facilities:

Basha Diagnostics
- Multiple locations MRI and CT

Millennium Diagnostic Center
- Southfield (CT and MRI)

Physical Therapy

ATI Physical Therapy
- Multiple locations

Team Rehabilitation
- Multiple locations

Durable Medical Equipment (DME):

Michigan Orthopedic Services
- Multiple Michigan Locations

Wright & Fillipis
- Multiple Michigan Locations

Binson’s Medical Equipment and Supplies
- Multiple Michigan Locations

EXPERTISE makes the difference graphic