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12555 W. National Avenue

Suite 201

New Berlin, WI 53151

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Phone

262-754-8005

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Fax

262-754-8003

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By Appointment Only

Hours:

Monday 9AM-6PM

Tuesday 9AM-6PM

Wednesday 1-5PM

Thursday 1-5PM

Friday 9AM-5PM

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

 

wapcp_forms_v7.pdf
Patient Forms - Click to download

 The forms are saved as PDF files and require a PDF Reader to open. For your convenience, below is a link to FREE Adobe Reader.