Medical Release of Records Form
Medical Release of Records
If you are going to see one of our practitioners at Serenity Health Care Center and would like to transfer your records from another office, please download the Medical Release of Records form. You may fax it to 262-522-8640 prior to your appointment and we can get those records ahead of time or bring it with you on your first appointment. We will be happy to obtain those records for you.
Serenity Health Care Center will assist you by filing insurance claims. If you have any questions regarding coverage, please contact your insurance company prior to your appointment. Since we are considered a non--‐‑traditional clinic, some of the tests and services, as well as the office visit, may not be covered. Payment due at the time of your appointment will be at least 50% of the office visit charge. All other charges must be paid in full on the date of service including supplements and services that are unbillable to insurance.
Dr. Muth does NOT accept Medicare or Medicaid. Dr. Konetzki only accepts Medicare he does NOT accept (HIRSP, Forward Health, Badger Care, etc.). Claims can only be submitted to Medicare if you see Dr. Konetzki.
We accept cash, checks and credit cards. Checks returned as NON--‐‑SUFFICIENT FUNDS will be charged a $25.00 fee plus the bank fees that are charged to SHCC by our financial institution.
We at Serenity Health Care Center understand that a person’s schedule can change, necessitating rescheduling of your appointment. We appreciate at least 72 hours notice for new patient appointment cancellations and a 24 hours notice for follow--‐‑up appointments. The $150.00 deposit will be kept for any new patient cancellations that are less than 72 hours and half of the office visit fee will be charged for any follow--up visit cancellations less than 24 hours if we are unable to fill this appointment with another patient.