Once you have scheduled your intake appointment, please:
- Complete the following forms:
- HIPAA Data Use Agreement
- Consent for Treatment
- Billing Consent
- Patient history form
- Request for Treatment, In Your Own Words
- Make a copy of your insurance card, front and back
- Fax the above completed forms, and a copy of your insurance card to: 920-694-3271
- Read the following:
- If you wish to communicate by email or request refills and schedule appointments electronically, please ask to have your onpatient portal activated so that you can send us messages.
- To release/exchange your medical information from CAPC to others, please open the Release of Information form to print, fill out, and fax back to CAPC, LLC at 920-694-3271