731-541-6939 Office
731-541-4570 Fax
Richard K. Wagner, M.D., FACOG
Nathan J. Hoeldtke, M.D., FACOG
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Information for Patients
Welcome to Our Front Desk
You can print and complete the following forms prior to your first visit with us. If you bring these completed forms to your visit, it will shorten waiting times and allow us to most efficiently serve you.
If you have questions about these forms, please contact our office.
In addition, this will allow time for you to contact family members as needed to obtain any important family history that you may not remember or know.
Registration Forms
- Financial Agreement
- Patient Information
- Insurance Information
- HIPAA Compliance Form
- Release of Medical Information
- Personal and Family Medical History
- Patient Satisfaction Survey
Clinic Policies
- View Policies (this is for your review and information)
Other Forms
En Español
- Divulgación de información médica por medios alternativos
- Información del seguro
- Información del fiador
Premier Services
- Routine and high-risk obstetric ultrasound
- Preconceptional care
- Genetic counseling
- Prenatal diagnostic procedures
- Targeted sonographic evaluation of fetal anomalies and growth disorders
- Fetal echocardiography
- First trimester nuchal translucency evaluation
- Fetal transfusion
- Antepartum fetal surveillance
- Consultative or primary management of medical complications in pregnancy
- Inpatient consultation and management
- Management of diabetes in pregnancy
- Beneficial features include:
- Physicians board-certified in maternal-fetal medicine and obstetrics and gynecology
- Registered Diagnostic Medical Sonographers
- Three-D Ultrasound
- Expert compassionate staff
