Your time with your Primary Care Provider (PCP) is valuable and we require certain forms to help you make the most of your visit.  The following forms are required and can be completed at home or at PCHC and submitted prior to your first visit. These forms are also necessary in order to schedule your first appointment. Thank you!

1. Complete the New Patient Registration Form.
2. Complete the Health History Questionnaire.
3. Review the Notice of Privacy Practices.
4. Complete the Release of Information Form.
5. Review the Purchased/Referred Care Booklet.
6. Review the Patient Rights and Responsibilities.
7. Complete the Release of Tribal Verification or Enrollment Form. (If applicable)
8. Complete the TeleHealth Informed Consent Form.
9. Complete the Delegation of Parental Power Form.

If you have any questions or would like assistance in completing any of these forms mentioned above, please call our main number at (715) 588-3371.

To access and find more information about the LDF Healthier Community Action Team website, go to www.ldfwellness.org