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PATIENT FORMS

New patients are asked to provide our office with a complete set of forms that include patient registration, medical history, list of medications, patient consent, authorization for disclosure of health information, and a written acknowledgement of our privacy policy, office policies, and no show/cancellation policy.

  1. Please download the complete packet of forms and save it in your computer.
  2. Fill in the forms using the writable PDF functions, OR print the forms and fill them out with a pen.
  3. Print the completed forms.
  4. Fax a copy to our office at 262-754-8003 one week prior to your first office appointment, OR mail the forms to:

West Allis Primary Care Physicians
12555 W. National Avenue - Suite 201
New Berlin, WI 53151-4061

PDF Patient Forms - Click to download