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Financial Policy

Authorization Form for Release of Last Vision Health Records

Authorization Form for Release of Last Clinical Summary & Medication List

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Our Office

1081B W. Fond du Lac St.
Ripon, WI
54971

920-748-1497
Ripon@wec2020.com Contact Page Request an Appointment

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Office Hours

Monday
9:00am - 6:00pm

Tuesday
9:00am - 6:00pm

Wednesday
8:00am - 5:00pm

Thursday
7:30am - 5:30pm

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By Appointment Only

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Patient Forms_{Scroll for More}

Financial Policy (PDF)HIPAA Form (PDF)Authorization Form for Release of Last Vision Health Records (PDF)Authorization Form for Release of Last Clinical Summary & Medication List (PDF)