Align Clinic WI
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    • Emery Maloney, CO
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Patient Resources

​Forms & Information

Patient Satisfaction Survey
  • Patient Information Form (Editable PDF) / ​Fill out online
  • WCR Brace Disclaimer Form (Editable PDF) / Fill out online. 
  • Out-of-Network Provider Notification Form (Editable PDF) / Fill out online. 
  • Scoliosis Patient Update Form (Editable PDF) / Fill out online
  • HIPAA All in One Form (Editable PDF) / Fill out online
  • WCR Brace ABN Form (Editable PDF) / Fill out online

Patient's Rights Policy
Consent to Treat and Assignment of Benefits
Notice of Privacy Practices
List of EOS (x-ray) imaging centers

The 3 imaging centers closest to AC Wisconsin are:

​Children's Hospital of Wisconsin
8915 W. Connell Ave. 
Milwaukee, WI  53226
Phone:  877-607-5280
Hospital Website

Minnesota

GILLETTE CHILDREN'S | ST PAUL CAMPUS
205 University Avenue
St Paul, MN  55101
Hospital Website

MAYO CLINIC HOSPITAL | SAINT MARYS CAMPUS
1216 2nd St SW
Rochester, MN  55902
Phone:  507-538-3270
Hospital Website


Picture

Insurance Network Status

 In-Network:
  • Aetna of Texas ~ Commercial MCR/MCD​
  • Arise
  • Care Wisconsin
  • Children's Community Health Plan
  • Common Ground
  • Community Care ~ Medicaid
  • Cypress
  • EBSO
  • WI Forward Health
  • Health Partners
  • Homelink
  • Humana
  • iCare
  • iLife
  • Inclusa
  • IRIS (iLife)
  • Lakeland Care
  • Managed Health
  • Medicare
  • Molina ​
  • Multiplan
  • Network Health
  • Pekin
  • Prairie States
  • Tri Care - North
  • Trilogy 
  • United Health Care
    • HMO, PPO & MCR / MCD
  • VA ~ Veterans Administration
  • WEA Trust
  • WPS  
Out-of-network but can bill PPO:
  • Aetna
  • Cigna
  • Health Net
  • Prevea

Out-of-network and unable to bill
  • Aetna HMO
  • Cigna HMO and EPO
  • Health Net HMO and EPO

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Copyright Align Clinic, LLC 2012-2021. All rights reserved. These are opinions only and viewers are at their own risk when acting upon the opinions therein. No part of the contents of this website or photos, videos images therein may be transmitted, copied or reproduced by any way without written permission.
  • News & Events
    • Past Events >
      • News & Events
  • Patient Resources
    • Contact Us
    • Viewing/Saving X-ray CDs
    • Taking Clinical Photos
    • Hotels/Attractions
    • WCR Certified Practitioners
    • WCR Contacts
    • Brace Colors
  • AC Wisconsin
    • Location
    • Contact Us
    • Emery Maloney, CO
    • Support Staff >
      • Lynn Chervenka, OA
      • Marsha Holtzheimer, OA
    • Patient Testimonials
    • Inside Wisconsin
  • WCR BRACE CLINICS
    • USA - WCR Brace Clinics
    • International - WCR Brace Clinics
    • WCR Brace Clinic Finder
    • Brace Clinics Calendar
    • Past Brace Clinics
  • Schroth Therapy
  • Scoliosis
    • WCR Scoliosis Brace >
      • Brace Colors
      • Brace Articles
      • Grant's MS Thesis
      • Scoliosis Fashion
    • Case Presentations
    • Adult Scoliosis Bracing
    • Patient Sports and Hobbies
    • Product Endorsements
  • Orthotics
    • Pediatric Orthotics
    • Foot Orthotics (FO)
    • Ankle Foot Orthotics (AFO)
    • Knee Ankle Foot Orthotics (KAFO)
    • Cranial Remolding Band
    • Soft Goods
    • Orthotic Product Endorsements
  • Hope's Embrace® undershirts
  • Blog
  • Careers