Please print and complete the first form, Patient Demographics, and bring it with you to your first appointment.
We value and protect your privacy and confidentiality. As a patient, we encourage you to review our policies and notices:
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TRANSFER MEDICAL & DENTAL RECORDS
Please fill out the following form and send to LCHC for consent to obtain/release your medical and dental records: Consent for Release of Records
FAX TO: 920-686-0352
Please Call 920-686-0453
*Once submitted, medical and dental records may take up to 30 days to transfer.