Business Office
715.552.9784
2403 Folsom St
Eau Claire, WI 54703
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Fax: 715.835.6370
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View and Print Forms
Authorization for Disclosure of Health Information
Authorization for Treatment of a Minor
Medicare Wellness Exam Questionnaire
MyChart - Consent for Proxy Access
MyChart - Mobile App Instructions
MyChart - Video Visits Tip Sheet
New Patient Packet - Pediatric
Notice of Privacy Practices (Spanish)
Patient Financial Responsibility, Assignment of Benefits, and Authorized Representative Agreement