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Forms

Save time by completing and submitting online forms

For your convenience, registration forms are available online. We request all new patient and previous patient registration forms be completed and submitted at least two weeks PRIOR to your initial appointment. The registration from process is separate from our Patient Portal.  If you need assistance with the patient portal please call our office.

Registration Form

Please review Medical Records, Insurance and Worker’s Compensation/Third Party Liability information below, as it is important information pertaining to your initial appointment at Hand to Shoulder Center of Wisconsin.

What to Expect Prior to an Appointment

Patients will receive a text or voice reminder prior to each visit.   The text reminder will have the option to confirm or cancel the visit. Additionally, with the text reminder patients can annually acknowledge HIPAA and Consent to Treat forms.  Likewise, each visit, review personal demographics, medications, allergies, and surgery history.  Click here for a preview.

No Show Appointment Policy

It is important to attend scheduled appointments. If you do not show up for your scheduled appointment, you will receive and automated message from the clinic to call to reschedule your appointment. If you have three consecutive appointments that you do not show, our clinic policy is to cancel all of your future appointments and a charge may apply.

Medical Records

It is imperative that our office receive all medical records pertaining to the condition for which you will be seen. Contact your referring physician and request your medical records and imaging studies/diagnostic test (x-rays or MRIs) be faxed or mailed to Hand to Shoulder Center of Wisconsin prior to your appointment visit with us.

Advanced Directives

The government mandates that we offer Advanced Care Directives for surgical patients of Hand to Shoulder Center of Wisconsin and Woodland Surgery Center. If you do not have a Living Will or Power of Attorney for Healthcare, please contact us immediately at (920) 730-8833 or toll-free at (888) 383-3039 and ask for Central Scheduling. Forms to complete will be mailed to you, or go to the provided links below to print the forms:

http://www.dhs.wisconsin.gov/forms/AdvDirectives/F00060.pdf

http://www.dhs.wisconsin.gov/forms/AdvDirectives/F00085.pdf

Insurance

We accept most insurance; however, if your insurance policy requires an authorization to be seen by a specialist, it is your responsibility to obtain that authorization. To verify your insurance policy requirements, call the toll-free number on the back of your insurance card(s). If authorization is needed, all authorization documents must be received by Hand to Shoulder Center of Wisconsin prior to the time of your appointment to receive the best possible insurance benefits available to you.

All insurance copays will be collected at the time of your appointment.

Worker’s Compensation

Should your health condition be work-related we require both your health insurance information and worker’s compensation insurance at the time of your initial appointment. Also, please remember to bring your driver’s license or another form of photo identification, insurance card(s), copay and labeled prescription medication bottle(s) to your first appointment. If you have any questions, please contact us at (920) 730-8833 or (888) 383-3039.

Forms (Disability/FMLA, ETC.)

Requirements:

  • A one-time $10 administrative form fee payment is required prior to our clinic completing the form.
    • Payments can be made at the clinic or via credit card/debit card by calling 920-730-8833.
  • An authorization form must be included with the submitted form. Per HIPAA, we cannot share your Personal Health Information without your signed authorization.
  • Forms will be completed within 5-7 business days.
  • Forms may be submitted
    • Mail: 2323 N. Casaloma Drive, Appleton, WI 54913
    • Fax: 920-738-1974
    • In Person: drop off at clinic front desk
    • Email: [email protected]

Video instructions for using an iPhone to scan and send forms.

Hand to Shoulder Center of Wisconsin complies with applicable Federal Civil Rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Hand to Shoulder Center of Wisconsin does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. Please visit our homepage (scroll down) for more information on free sign language services and free language interpreter services for those whose primary languages is not English.