To save time on your first visit, you can complete the required intake forms ahead of time.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary forms and complete the required information.
- Fax (715-262-8744) or email ([email protected]) your completed forms or bring them with you on the day of your appointment.
New Patient Health History Intake
Adult Intake (Age 18-64)
Financial-Release-Consent Policies.pdf
Pediatric Intake (Newborn to Age 17)
Financial-Release-Consent Policies.pdf
ConsentToTreatMinor.pdf (Parent/Guardian must sign this form for all minors under the age of 18 prior to being seen)
Financial-Release-Consent Policies.pdf
Medicare Intake (Age 65+)
Medicare ABN (Medicare patients only)
Medicare Disability Index (Medicare patients only)
Financial-Release-Consent Policies.pdf
For Your Information/Additional Forms:
General Release of Information
HIPAA COMPLIANT AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION.doc
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