LakeView Medical Center - Pre Registration
For more information, please call us at
715-234-1515

Pre-Registration Application


You are Pre-Registering for Lakeview Medical in Rice Lake, WI.

Patient Information: (Fields marked with an asterisk are required.)
*First name:
*Middle name:
*Last name:
Maiden Name:
*Address:
*Home Phone:
Cell Phone:
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*Email Address:
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*Patient Date of Birth:            
Social Security Number:
Employer Name:
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Interpreter Needed :