Patient Forms and Insurance Information
Planning your first visit to Northland Gastroenterology? On this page, you'll find the information you need to get started, such as new patient forms which you can print out and complete prior to visiting our office.
For your convenience, our patient forms are located below. Please download, print and complete the following forms so we can expedite your first visit:
- Health Questionnaire
- Patient Registration Form
- Medical Record Release
- Lakewalk Ownership Disclosure (for patients scheduled at Lakewalk Surgery Center)
- HIPPA February 2018
- Notice of Privacy Practices 2018 February
- Preparing for you COLONOSCOPY
- Colonoscopy: Preparing for with MOVIPREP
- Colonoscopy: Preparing for with NuLytely
- Colonoscopy: Preparing for with Suprep
- Preparing for your EGD
- Preparing for your ERCP
- Preparing for your PillCam small bowel capsule endoscopy
In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
Insurance and Billing
Check with your insurance carrier prior to your visit to make sure that Northland Gastroenterology PA is part of your network. Your health insurance is a valuable asset; you should know and understand completely the terms of your contract. Because of the number of insurance companies and plans available, we cannot keep track of individual plan definitions and requirements (pre-authorizations, pre-certifications, co-pays, waiting periods, and so on). The more you know about your own plan, the greater the benefit you can enjoy. If you have questions about your insurance coverage or the services that are covered, contact your insurance company directly. Their customer service department will be happy to answer any questions you might have. The number should be listed on your insurance card.
- Please bring to every visit:
- Your insurance card
- Government issued photo ID
- Co-payments are due the day of your visit
If you do not have insurance, call our business office to arrange payment. You are responsible for your bill, whether or not you have insurance. You will be asked to make some type of payment if there is an insurance delay. Overpayments will be refunded as quickly as possible.
Accepted Insurance Carriers
- America’s PPO
- BlueCross BlueShield
- Comprehensive Care Services
- GroupHealth Cooperative-Eau Claire
- Indian Health Services
- Itasca Medical Care
- Medical Assistance (MN and Wisconsin)
- Railroad Medicare
- Multiplan Network
- UnitedHealthcare (EXCEPT Wisconsin PMAP)
- WEA Insurance Co.
As a courtesy, we will file your claim to your primary insurance company for you. We also submit claims to secondary insurances.
- We accept Visa and Mastercard.
- If you have any questions about your bill or need to make arrangements for payment, please contact our business office at 218-724-3411.
What To Expect
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It will also help alleviate any unnecessary anxiety you may be feeling prior to your first appointment. Educate yourself on your symptoms by reviewing the content on this website. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.
Our practice is working together to realize a shared vision of uncompromising excellence in gastroenterology.
To fulfill this mission, we are committed to:
- Listen to those we are privileged to serve.
- Earn the trust and respect of patients, profession and community.
- Exceed your expectations.
- Ensure a creative, challenging and compassionate professional environment.
- Strive for continuous improvement at all levels.