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Forms & Releases

PANDAS/PANS New Patient Form

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For new patients, please complete the initial PANDAS/PANS Questionnaire and Autoimmune Family History.  It can be submitted by either faxing it to our office at 262-785-1555 or submitting it through our website here when finished. Someone will be in contact with you within 3-5 business days.

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New Patient PANDAS/PANS Assesment - Click to Open and Download or Print.

Autoimmune Family History-Click to Open 

and Download or Print

Release of Information Form

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For the Release of Information form, either print the form, fill it out and fax it back to our office at 262-785-1555 or download the form, fill it out, and then submit it through our website here.

Release of Information Form - Click to Open and Download or Print.

Completing Forms Online

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To complete the forms online, they can be downloaded and completed in Adobe Acrobat. Alternatively, they can be uploaded, completed, and saved via PDFescape, a website that is completely free and requires absolutely no personal information.

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All completed documents can be easily uploaded here.

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