Patient Forms

We offer language assistance and American Sign Language (ASL) interpretation services for our patients. Please notify us if you primarily speak a language other than English or communicate using ASL and would like interpretation assistance at your appointments.
Forms can be challenging, frustrating, irritating, and annoying (need we go on?). Providers and staff feel the same way. WMC pledges to only give out forms when absolutely in your best interest or as a regulation requirement. WMC does need forms completed at specific times to provide you with the high-quality, safest care. The care we give, even if it includes forms, is the same care we want for our family and friends. Thank you in advance for your sensitivity and agreeing to completing our forms!

New Patients
​(all ages)

Please click the below links to complete these forms electronically prior to your first visit at our office.

New Patient Information

New Patient Health History

Authorization to release medical records

​Televisit Consent 
​(Please note that your first visit may be an in-person office visit. Complete this form now for potential future televisits.)

Consent to treat a minor
(for patients under age 18)

Controlled Substances Agreement & Letter 
(completed after establishing care)

Current Patients (all ages)

Please complete the Patient Information Update each calendar year prior to your visit at our office.

You may request medical records by completing the Authorization to release medical records. Use this form to request a personal copy of your medical records, send your records to an outside entity or transfer records from a different clinic to WMC.

For patients under age 18, please complete the Consent to treat a minor only once. All children with the same parent/legal guardian may be listed on this form. (If you have already completed this form previously, please skip this form. Please contact our office with any questions about this form or if you are unsure whether you should complete this form.)

We are here to support you with advanced care planning. Our Care Team is available to help you with your Living Will, Advance Directives, and Medical Power of Attorney forms. Click here to learn more about our Advanced Care Planning service at WMC. You can also download the forms below.
Annual wellness visit for ages 65+
Click here to complete your wellness visit questionnaire online
​
Annual wellness visit/physical for ages 0-64
COMING SOON!