New Patient Intake Forms
Save some time at your first visit!
We are happy to offer our new patient forms online to be completed at your convenience in the comfort of your own home. Theses forms help let us know the history and current state of your health, the reason for care, and much more. If paper forms are preferred, those can be picked up prior to your appointment during regular business hours.
Additional signatures will be required at the time of the visit and a Parent/Guardian is required to accompany any minor.
~ Download the necessary forms below, print it out, and fill in the required information.
~ Make a copy or send a photo of the front AND back of any applicable insurance cards.
~ Send us your completed forms or bring them with you to your appointment (email is not recommended for protected health information).
mail: 1020 Truman St. Suite B, Kimberly, WI 54136
email: [email protected]
health-questionnaire.pdf (all patients) accident-intake.pdf (auto, work, personal injury)