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Click on the link to fill out client intake information. Please print and bring the completed forms to your appointment. Please do not send these forms via email to protect your privacy.
If you are seeing Linda Poirier, please complete forms 1 and 2. If you are seeing Kim Schmidt, please complete forms 2 and 4 through 7 depending on your age. If questions, please call the office 715-832-9292
- Patient Health Information
- Patient Demographics
- Release of Information
- Child/Adolecent Client Intake Form
- New Patent Questionnaire Adolescent
- New Patient Questionnaire Adult
- Adult History Intake
Willow Creek Women's Care is a participating provider for the following insurance companies:
- Anthem Blue Cross Blue Shield
- Group Health Cooperative
- Medica
- Great West
- WEA Trust
- Security Health Plan
- Aetna
- Humana
- Benefit Plan Administrators
- United Healthcare
- Wisconsin Medicaid and Family Planning Waiver
- Operating Engineers 139
- Midwest Security
- TRICARE
- Wisconsin Carpenters
- HealthPartners
- Medicare
- Advocare
- WPS
This list is not all inclusive and does not guarantee coverage. We suggest that each patient check with their policy for details of coverage.
Office Manager, Sally submits all insurance claims and handles all billing processes. All inquiries should be addressed to Sally. She can be reached at 715-832-9292 or using the following email: . info@willowcreekclinic.com
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