Our contract with United Healthcare is scheduled to end on April 30th, 2024. Unfortunately, after this date, we will no longer be able to accept United Healthcare insurance. If you have any questions about your insurance coverage, we recommend contacting your insurance company directly. They can provide more details about your policy and help you understand your options. If you have any questions about how this change will affect your billing, please do not hesitate to contact us at (608) 227-7007.
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Patient Forms

Physicians for Women - Melius & Schurr Contents For Patients Patient Forms

 

Patient Forms

New Patients

Please print, fill out, and bring these forms to your first appointment.

Additional new patient forms will be signed in our office. Please reach out to our office at (608) 227-7007 with any questions.

All Patients

For any appointment, please bring:

  1. A photo identification card
  2. Your current insurance card

and be prepared for any co-payments your insurance plan requires; co-payments are due on your date of service

Preventative Visit

If you are coming to our clinic for your preventative visit, please read this flyer on the difference between a Preventative Visit vs. an Office Visit.

Authorization for Release of Medical Records

The following form requiring your signature is necessary before any records can be released to us.

The following form requiring your signature is necessary before any records can be released FROM us.

 

 

Conditions & Treatments

How Can We Help?

 

Location

Physicians for Women - Melius & Schurr
2955 Triverton Pike Drive
Madison, WI 53711
Phone: 608-227-7007
Fax: 608-227-7027

Office Hours

Get in touch

608-227-7007