- Patient Forms
Welcome to Associated Physicians! If you are a new patient, please complete the New Patient Registration form and bring it with you to your appointment.
Workers’ Compensation/ Third Party Liability Patient Forms
If your visit pertains to an injury sustained at work, in a motor vehicle accident, or other event for which someone else is liable, please come ready with the claim information. The two linked forms below will help you to gather this information so we can correctly bill for your visit.
Third Party Liability
These forms will help our health care providers to better prepare for your visit.
Release of Medical Information to another Individual
Use this form to authorize Associated Physicians to discuss or disclose your protected health information to the people that you specify.
Access to another Patient's MyChart
Complete this form to allow others to view your online medical information via MyChart.
Transfer of Medical Records
To request copies of or to transfer your medical records, you must submit a request in writing using the Authorization for Release of Protected Health Information form below. Your records will then be copied or transferred to the requested person/facility.
Please note that your request may take 1-2 weeks to process, depending on the amount of information requested.
If you or your loved one needs help making decisions about healthcare, you can find Power of Attorney and Living Will forms on The Wisconsin Department of Health Services website. http://www.dhs.wisconsin.gov/forms/AdvDirectives/
Please present these forms when you arrive for your visit.
We are happy to have the opportunity to provide care for Medicare patients. As you know, Medicare is a government administered program designed to ensure that people in need have access to health care. To monitor this program, the government has several processes and forms in place that may be new to you. We are required to strictly adhere to the Medicare requirements detailed on this site (click here to review the Medicare eductational resources.)
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