Patient Forms

We ask all new patients to complete a medical history and to review and sign our HIPAA and payment policy form when you check in for your first appointment. To expedite this check in process, you can print and complete these forms ahead of time and bring them to your first appointment.

HIPAA and Payment Policies

Minor Patient Form

Release of Information
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"Dr. Campbell and her staff at the De Pere clinic were great! They made me feel comfortable as possible. I appreciate all the effort!"
- Daniel, De Pere patient

"Dr. Maggiolino has the greatest sensitivity and kindness with his patients; it is very easy to place complete trust in him."
- Barb, Grafton patient

"I have gladly recommended you to friends and family! I was completely satisfied!"
- Andy, Marinette patient

"Everyone was very friendly. The staff was professional in their approach and bedside manner, explaining procedures, treatments and recommendations very thoroughly. I will definitely return!"
- Robert, Manitowoc patient

"Doctor did a great job explaining the process and did a beautiful job stitching up my wounds after the Mohs surgery."
- Dawn, Appleton patient

"I am very pleased with the results of my surgery, as I have a minimal scar and no pain."
- Patricia, Sturgeon Bay patient

"I had a great experience and have already referred others."
- Tara, Green Bay patient
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