Patient Preregistration

Take advantage of our secure online registration process by completing the information requested below. This will speed up your registration on the day of your visit.

Please complete the form below at least two business days before your visit. Fields marked by an asterisk (*) are required. If you need assistance while completing the form, please call 715-838-3110 option 1 or toll free 888-838-6193, option 4, then option 1.
Patient Care Provider
* Patient Care Facility:
* Other Facility:
* Physician ordering the test/procedure:
* What is the test/procedure:
* Expected date of your visit:
* Have you been seen in the last 30 days?: