VICTORIA J. MONDLOCH, M.D.
20800 SWENSON DR. SUITE #425
WAUKESHA, WI. 53186
WELCOME
As a new patient we would like to welcome you to our practice! We look forward to taking care of
your needs and/or questions regarding your health at your up-coming visit. Addressing the needs of
each patient as a personalized approach is a priority in our practice.
We ask that you fill out the patient information sheets enclosed and bring them along to your visit. If
we are filing to your insurance(s) company, it is important you call your insurance company to notify
them of your office visit to avoid any concerns with coverage. Please remember that you will be
responsible at the time of your visit for any co-pay or deductible that coincides with your insurance
company. It is also necessary to bring your insurance card for filing purposes and driver’s license as a
secondary ID. These will be verified and copied at each office visit per healthcare guidelines.
If you have any questions or concerns before your scheduled appointment feel free to contact us.
We ask that you arrive 15 minutes prior to your scheduled appointment time. We take our
appointments very seriously and are always thinking of how we can better serve our patients. If you
must reschedule your appointment we ask that you call us 24 hours in advance to prevent being billed
for that service. We value the time we’ve set aside for you.
Your appointment with Dr. Victoria Mondloch is scheduled for ________________, ______________
at ________ am/pm.
Thank you.
Phone : (262) 524-9116
Fax:
(262)754-4944