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Policies and Legal Forms

Online Privacy Statement

We value our relationship with you and we work hard to keep your medical information confidential. Learn more about how we safeguard your online information.

Privacy Practices (HIPAA)

Your health information is protected by strict guidelines. There are instances when we need to release this information to a third party. You can find out more in our Privacy Practices in English, Spanish, and Hmong.

Patient’s Rights and Responsibilities

Understanding your patient rights and responsibilities is important to everyone. For your convenience, we have provided ThedaCare’s Patient’s Rights and Responsibilities in English, Spanish and Hmong.

Payment Options

If you’ve received a bill from ThedaCare, you have options. We welcome the opportunity to assist you in finding the option that works for you. ThedaCare provides healthcare services to everyone regardless of their ability to pay. Find out more about our Payment Options.

Standard Hospital Charges

The federal government requires each hospital to post on its website a list of its standard charges for each inpatient and outpatient service and item provided by the hospital. Find out more about standard hospital charges.


ThedaCare values the unique characteristics, experiences and perspectives of the people that live in our communities. Find out more about how we embrace our diverse communities.

Advance Directives/Power of Attorney for Healthcare

Sometimes others must help you make your healthcare decisions. For your convenience, we’ve provided the needed forms and instructions.

Health Release Forms

These forms allow ThedaCare to transfer your medical records to another provider or give medical treatment to your child in your absence. Find out more

For more information on medical records, please call our Health Information department at (920) 729-2164.

Access to Online Medical Records

ThedaCare now offers an Online Medical Record Request tool for the following individuals to request patient records:

•Patients requesting their own records

•Parents of minor patients requesting records

•Caregivers acting on behalf of a patient (i.e. Power of Attorney)

The Online tool verifies your identity by asking for a photo of your driver’s license, which can be taken via webcam or smartphone. There is no additional charge to use this service.

Please note, Chrome, Safari and Firefox are the recommended browsers for this application. If you encounter any issues with your electronic request, please call (920) 454-5538. 

Form Completion Request

Form Completion Request can be downloaded here.

Cost Estimate Tool

Use the Cost Estimate tool for a price estimate on over 300 services with standard prices to better understand healthcare services and cost of care. Search procedures and services here.

If you have questions about the estimate, please call (800) 236-4102.

If you have questions about financial options such as a payment plan or financial assistance, please call (800) 236-4102.

Terms of Website

Website Terms can be accessed here.

Virtual Health Services End User Agreement

ThedaCare created and maintains Virtual Health Services, which include online Video Visits and medical online questionnaires (eVisits), to provide interactive access to our healthcare providers. Video Health Services may include communication via video, audio, in-app messaging, emails, tablets, and smartphones. Your access to and use of this Service is subject to the terms outlined in ThedaCare’s Virtual Health Services End User Agreement.

Website Notice of Virgin Pulse/Welltok Data Breach

Our vendor Virgin Pulse/Welltok, Inc. was impacted by the MOVEit Transfer software security incident, which affected certain patients’ personal information. Learn more.

Website Notice of Pope & Conner Consulting, Inc. Data Breach

Our vendor Pope & Conner was impacted by a software security incident, which affected certain patients’ personal information. Learn more.