Forms and Insurance Information

Forms needed to be completed upon check-in


When you arrive for your appointment, you will be asked to complete the following forms. Feel free to print these and fill them out in advance.

Release of Info MTM

If you are using their medical transport

WHODAS

World Health Organization Disability Assessment Schedule

You will be asked to sign the following forms in person, but feel free to read in advance


Insurances Accepted


  • Medical Assistance/ Badger Care/ Forward Health
  • Group Health Cooperative of Eau Claire
  • Physicians Plus
  • WPS
  • Unity
  • Quartz
  • WEA
  • Care Wisconsin
  • Alliance
  • CCF (Children Come First)
  • SISCO
  • MMSI
  • Humana
  • And many other insurances that offer Point of Service Plans

Please call or check with your individual insurance provider for more information.

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