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Forms

Forms

Forms

You may download and print the following forms on your personal computer.  Please fill out the forms and bring them to your appointment.  Do Not Mail or Email.

To be filled out prior to your appointment:

       AUTHORIZATION FOR ORAL RELEASE OF MEDICAL INFORMATION TO FAMILY OR FRIENDS

       CANCELLATION POLICY

       DEMOGRAPHIC FORM

       HISTORY & PHYSICAL

For your information:

       FINANCIAL POLICY

       NOTICE OF PRIVACY PRACTICES

  • About
  • Contact
  • Forms
  • Home
  • Insurance
  • Physical Therapy
  • Services
  • Topics of Interest

Contact Info

171 South Lake Ave. Phillips, WI

715-339-6140 phone

1-888-412-1366 fax

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