Hospital   

   Clinics   

 Fitness Center 

Patient Resources

Queen of Peace Clinics offer a variety of resources for patients to improve the quality of your experience. We are dedicated to providing you with the best possible medical care available.

• Scheduling Your Appointment
• Patient Information Form
• Credit Policy
• Notice of Privacy Practices
• Release of Information Requests
• Billing Questions

Scheduling Your Appointment

To schedule an appointment with a physician or nurse practitioner, call the clinic office directly. Phone numbers are shown at left.

For directions and more information about each clinic, click the clinic name.

Patient Information Form

We ask our patients to fill out a Patient Information Form annually, so we can keep our contact and insurance records up to date. To help us serve you better, you can download, print, and fill out this form at home before you arrive. Bring the completed form to your appointment to shorten your wait time.

• Click here to download a Patient Information Form.

Credit Policy

Our Credit Policy document describes our fee and payment policies for all patients, with or without insurance. In an effort to avoid any misunderstandings, we ask that all patients read and sign this credit policy. You may download and print this policy, then read and sign it before your appointment to save time in the office.

• Click here to download a Credit Policy document.

Notice of Privacy Practices

Queen of Peace Clinics' Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully!

• Click here to download Queen of Peace Clinics' Notice of Privacy Practices.

Release of Information Requests

If you ever need to request that Queen of Peace Clinics release your protected health information for any reason, we will need you fill out and sign an authorization form for this request. Download and print, then fill out the Authorization to Disclose and Patient Request for Access to Protected Health Information form. You can drop off the completed form at your clinic office, or fax it to the number shown at the top of the form.

• Click here to download a Release Authorization Requestform.

Billing Questions

If you have questions about your bill, insurance coverage, or other payment issues, the Business Office staff is available to help you. Call any of our billing staff during regular weekday business hours, and they will research your question, make necessary connections for you, and clarify charges or credits.

You can contact the Business Office by phone at 952.758.1050.