Intake Forms

Welcome New Patients

At Fenske Holistic Healthcare LLC, we appreciate the trust you have placed in us to work together with you to regain and maintain your health.  We pride ourselves in our commitment to our patients.  We look after each patient as we would the closest member of our family.

After calling our office to schedule your initial appointment, please complete the appropriate forms provided below.  Based on the initial appointment you scheduled you would select forms for either Chiropractic, or one of the levels of Functional Medicine.  Initial Functional Medicine appointments will require a Request for Medical Records form to be returned to our office within 2 days of scheduling your appointment so Dr Fenske can review your medical history before your appointment. You may download the forms from our website and print them, fill them out and return by mail or fax, or scan them and email them to Info@DrFenske.com.  Please keep a copy of any mailed forms in case we do not receive them.  The Patient Acceptance Form below gives detailed information on what Functional Medicine patients can expect leading up to, and during their initial office visits.  If you have problems downloading the forms we can email or mail them to you, or you may pick up blank forms in our office.

Chiropractic AND Functional Medicine patients please send us your paperwork one week prior to your initial appointment (email to Info@DrFenske.com, fax to 608.836.8863, mail or drop off at the address below).  Although completing the paperwork will take time, the more I know about you the better I will be able to assist you.

We look forward to a long and positive relationship with you.  Please consider us your family holistic healthcare office and do not hesitate to ask us how we can be of help in any and all circumstances regarding your health and the health of your family.

Dr. Nicole Fenske

A Note About Chemical Sensitivity

During your visit to our office please be aware that many of our patients are sensitive to the chemicals and/or other ingredients used in PERFUMES, HAIR SPRAYS, and other SCENTED BODY PRODUCTS.

Privacy Policy

Notice of Privacy Practices – Click here to see how we protect your personal information.