HIPAA Forms

In compliance with Federal Law, Retina and Vitreous Consultants of Wisconsin, Ltd., has made available on this website the company’s Notice of Privacy Practices. This notice is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). In addition, medical records release and restriction forms, as well as our Patient Information document, are available.

If you are downloading medical records release forms for your usage, please note that once the forms are filled out, they must be either mailed to the Mayfair office at 2600 N. Mayfair Road, Suite 901, Milwaukee, WI, 53226, or faxed to 414-778-3446. These forms will not be accepted via e-mail.

You will need a PDF viewer to open the files. If you do not have one, you can download a free version of Adobe Acrobat Reader. If you have any difficulty downloading these forms, you may call our main office at 414-774-3484 or 800-837-3937 and our staff will happily mail them to you.