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4410 Regent St. Madison, WI 53705
Tel: 608-233-9746
Patient Forms
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Internal Medicine
Internal Medicine
OB/GYN
OB/GYN
Pediatrics
Pediatrics
Behavioral Health
Behavioral Health
Physical Therapy
Physical Therapy
General
Third-Party Liability
Third-party liability occurs when someone else (an individual, organization, or business) may have been responsible for your injury or illness. When this is the case, that entity or its insurer may be liable to pay your health insurance claims related to that injury or illness.
Transfer of Medical Records/Authorization for Release of Records
To request copies of or to transfer your medical records, you must submit a request in writing using this form. Your records will then be sent to the requested entity through a secure portal. Requests can take 1-2 weeks to process, depending on the information requested.
General
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