Online Forms

To save time on your first visit, we encourage you to complete the required intake forms before you come in to see us.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the appropriate intake form and financial agreement/consent to treat and complete requested info.
• Fax (715-262-8744) or email ([email protected]) your completed forms or bring them with you on the day of your appointment.

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New Patient Health History Intake

ADULTS (Age 18-64)

Adult Intake  

Financial-Release-Consent Policies.pdf

CHILDREN (Newborn to Age 17)

Pediatric Intake 

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)

PREGNANT WOMEN

Pregnancy Intake 

Financial-Release-Consent Policies.pdf

MEDICARE (Age 65+)

Medicare Intake 

Medicare ABN (Medicare patients only)

Medicare Disability Index (Medicare patients only)

Financial-Release-Consent Policies.pdf

FULL LEGAL DISCLOSURE FORMS IN DETAIL:

General Release of Information

HIPAA Patient Notice

Financial Disclosure

HIPAA COMPLIANT AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION.doc

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