Now accepting Telehealth appointments. Schedule a virtual visit.



Hi from Rosenberg Medical Clinic,

Here are the intake forms we discussed. Click each link to be directed to the form. Once all are completed, please call our office to schedule an appointment (262) 242-0700. 

Looking forward to hearing from you.

  1. New patient information- 
  2. Review of Systems-
  3. Patient Health Questionnaire-
  4. Buprenorphine Agreement-
  5. Appointment Policy-
  6. Pharmacy Consent-
  7. Appointment Reminder Consent-
  8. Consent for General Care and Treatment-
  9. Patient Rights and Responsibilities-
  10. Privacy Practices Acknowledgement-
  11. Telehealth Service Consent-
  12. Release of Information-
Rosenberg Medical Clinic
1516 W. Mequon Rd., 103
Mequon, WI 53092
Phone: 262-333-0543
Fax: 855-457-1293
Office Hours

Get in touch