To save time on your first visit, you can download, print, and bring your completed forms with you!
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary forms, print, and fill in the required information.
- Fax (715-262-8744) or email ([email protected]) your completed forms or bring them with you to your appointment.
New Patient Health History Intake
Select appropriate option(s) below:
Adult Intake (Age 18+)
Pediatric Intake (Age 0-17)
Pregnancy Intake (If you are currently pregnant, complete these forms [Adult Intake is included])
Additional Required Forms:
General Release of Information
Medicare ABN (Medicare patients only)
Medicare Disability Index (Medicare patients only)
Consent to treat Minor (Parent/Guardian must sign this form for all minors under the age of 18)
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