Patient Registration

Save yourself some time by downloading, printing and filling out our New-Patient Package prior to your visit. Simply bring the forms with you to your first appointment and you will be able to sit back and relax. If you have any questions about the forms themselves, please feel free to call us at Racine Phone Number 262-634-4646 – we’re always happy to help!

  • New Patient Package contains the forms that will be needed for your care and will help to expedite your appointment with Dr. Wagner.
  • Patient Registration is part of the New Patient Package. Available here for separate download.
  • Medical History is part of the New Patient Package. Available here for separate download.
  • Medication List is part of the New Patient Package. Available here for separate download.

The above forms are saved in PDF format. If you are unable to view them, please download and install the free Adobe Reader software.