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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.

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.

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.

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/Third Party Liability Coverage

Should your health condition be work-related or a third party liability claim, we require both your health insurance information and worker’s compensation/third party liability 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.

Release of Medical Information to Another Facility Form

 

 

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.