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Members Only Forms

Please note these forms are for members currently covered by Wisconsin Health Fund.  Any changes made are not guaranteed until received and reviewed by the Eligibility Department at WHF.  Please refer to your Summary Plan Description or refer to it on-line by going to our home page and clicking on “View your Summary Plan Description”, for all eligibility requirements. 

Call 771-5600 or (888) 208-8808 and ask for Customer Service if you should have any additional questions or concerns.

 

All forms should be mailed to:

Wisconsin Health Fund
6200 W. Bluemound Road,
Milwaukee WI 53213

 

 

Click on forms below to go to printable version:

 

 

Customer Service Medical Center Dental Center
 

Change of Address

Coordination of Benefits

Dependent Addition Form

Dependent Deletion Form

Life Insurance Beneficiary

Loss of Time Application Form

 


Registration

Adult Medical History

Pediatric Initial Visit

Privacy Practices

Financial Policy

Accident/Injury Questionnaire

Consent of Treatment for Minors
in Parent/Legal Guardian Absence

Patient Rights and Responsibilities


Medical Records

Health Information Disclosure
Authorization


Treatment

Initial Allergy Questionnaire

Initial Pain Management Questionnaire

Pain Management Agreement

Take Home Medication Verification

After Your Appointment Instructions

Consent of Treatment for Minors
in Parent/Legal Guardian Absence


Radiology

Initial Pain Management Questionnaire

BMD Questionnaire

 

 Sign In Form

Registration (English)

Registration (Spanish)

Acknowledgment of Receipt of Privacy Notice (English)

Acknowledgment of Receipt of Privacy Notice(Spanish)

Medical History

Medical History (Spanish)

Dental History

Dental History (Spanish)

HIPAA Privacy Policy

Record release form

WHF Dental Center Financial Guidlines (English)

WHF Dental Center Financial Guidlines (Spanish)

WHF Dental Center Policy (English)

WHF Dental Center Policy (Spanish)

 

 

 

 

    
 E-Mail:   WEBMASTER  at WHF IT Services

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