for our patients
Please return completed forms to your provider at your next appointment or mail them to:
Eau Claire Medical Clinic
703 W. Hamilton Ave.
Eau Claire, WI 54701
Please see below to find a list of downloadable forms that will help you get started as a new patient with Eau Claire Medical Clinic. All other forms will be provided to you upon your first visit with us.
New Patient Forms
Patients can authorize the release of their confidential
health information to a family member using this form.
Eau Claire Medical Clinic requires that a parent or legal guardian consent to the care of minor children. In the event that a parent or legal guardian is unable to consent to care the parent or legal guardian delegate the right to consent to another adult.
Patients can authorize the release of their confidential health information using this form.
We have made our forms available to you as Adobe Acrobat files for your convenience. When you click on the name of the form, it will automatically open in Acrobat Reader. Make sure you use the print button in Acrobat so the forms will print correctly.