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  • About WHF
  • Clinics & Pharmacy
    • Medical Clinic
    • Pharmacy
    • Dental Center
    • Patient Forms
    • Virtual Tour
  • Member Health Benefits
  • News & Updates

Patient Forms

Click below to access printable versions of our forms.

Medical Records Forms

  • Health Information Disclosure Authorization

Radiology Forms

  • Initial Pain Management Questionnaire
  • BMD Questionnaire

Treatment Forms

  • Initial Allergy Questionnaire
  • Medications to Avoid Before Allergy Testing
  • Initial Pain Management Questionnaire
  • Consent of Treatment for Minors in Parent/Legal Guardian Absence
  • Discharge Instructions

Medical Center Forms

  • Adult Medical History
  • Pediatric Initial Visit
  • Financial Policy
  • Accident/Injury Questionnaire
  • Patient Rights and Responsibilities
  • Privacy Practice Pamphlet

Dental Center Forms

  • Registration
  • Registration (Spanish)
  • Acknowledgment of Receipt of Privacy Notice
  • Acknowledgment of Receipt of Privacy Notice (Spanish)
  • Release of Dental Information Verbal
  • Medical History
  • Medical History (Spanish)
  • Dental History
  • Dental History (Spanish)
  • Dental Record Release Form
  • Privacy Practice Pamphlet
  • Financial Guidelines Policy
  • Financial Guidelines Policy (Spanish)
  • White Smile Enrollment (English)
  • White Smiles Enrollment (Spanish)

All forms should be mailed to:

Wisconsin Health Fund
6200 W. Bluemound Road,
Milwaukee WI 53213

Clinics & Pharmacy

Learn more about our Medical Center, Pharmacy, and Dental Center. Delivering the very best in health care services.

Member Benefits

Learn more about benefits available to member organizations covered by Wisconsin Health Fund.

Medical & Dental Center

6200 W. Bluemound Rd
Milwaukee, WI 53213

Google Maps

Pharmacy

6118 W. Bluemound Rd
Milwaukee, WI 53213

Google Maps

414-771-5606
800-527-2023

Contact WHF

Main Switchboard
414-771-5600
800-524-3538

Contact Us

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