Online Forms

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

HIPAA Patient Notice

Financial Disclosure

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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Office Hours

Our Regular Schedule

Monday

8:00 am - 6:00 pm

Tuesday

8:00 am - 6:00 pm

Wednesday

8:00 am - 6:00 pm

Thursday

AM by appt only

1:30 pm - 6:00 pm

Friday

8:00 am - 12:00 pm

Saturday

Closed

Sunday

Closed

Monday
8:00 am - 6:00 pm
Tuesday
8:00 am - 6:00 pm
Wednesday
8:00 am - 6:00 pm
Thursday
AM by appt only 1:30 pm - 6:00 pm
Friday
8:00 am - 12:00 pm
Saturday
Closed
Sunday
Closed

Location

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