NORTHWOODS FAMILY MEDICINE PATIENT INFO
New Patient Forms
April 1, 2026
We are currently migrating to a new records system. Our New Patient paperwork is now completed electronically! In order to schedule your first appointment with our care team, please give us a call and we can send you the forms via e-mail or text.
If you prefer to print our New Patient paperwork, you can print and complete these forms. We do not accept WALK IN appointments for new patients.
** PLEASE NOTE ** In order to be scheduled for a New Patient Exam, you must complete ALL the forms listed below AND submit them to our clinic BEFORE you can be scheduled.
- Past Medical History
- NWFM Billing and Payment Policy
- Demographics / General Info / Consent to Treatment
- Notice of Privacy Practices NWFM
- HIPAA
- Authorization to Disclose Medical Information and Request for Medical Records
Payment
- We are preferred providers for AETNA, Blue Cross, MultiPlan, Cigna, and TriCare. We submit claims to Medicare and Medicaid.
- We offer a 15% discount for patients paying cash at the time of their visit.
- NWFM Billing and Payment Policy
As a courtesy to you, our patient, we will bill your insurance and accept assignment of benefits for most insurance companies. However, it must be understood that the insurance contract is between the patient and the insurance company. The patient is fully and ultimately responsible for any and all charges that are not paid by the insurance company.
Pricing for Common Services
- TB testing: $40
- School Physicals: $60
- DOT Physicals: $235
Northwoods Family Medicine 