PATIENT ENROLLMENT

patient enrollment steps

STEP 1: CONTACT

Contact our Admissions Manager, Josie Lenz, at (920) 372-4168 or via email at admissions@sequoiaintegrativemedicalservices.com.

STEP 2: COMPLETE FORMS

Our Admission Packet consists of the following forms:

  • New Patient Admission Checklist
  • New Patient Questionnaire
  • POA/ROI Form
  • Consent to Treat
  • HIPAA Privacy Authorization Form
  • Telemedicine Consent
  • CCM and RPM Consent Forms
Sequoia Enrollment
STEP 3: SUBMIT FORMS

Submit completed admission packet via email or fax. 

Emailadmissions@sequoiaintegrativemedicalservices.com

Central Fax: (920) 543-5288

Western WI Fax: (715) 520-5288

Upon submission of forms you/your loved one will be placed on the provider’s schedule for a visit within the next calendar month. Once paperwork has been processed by our billing department (typically 1-2 business days) we are able to address and concerns/needs.

Do you have questions?