FORMS

This page holds forms designed to be helpful in working with our office.

Demographics

Patient History

HIPAA form

Medicare Wellness Forms

Record release

Sports Exam

Senate Bill 65

 

 

Christopher J. Verkler M.D.

Dr. Verkler holds a Bachelor of Sciences degree in Zoology and a Doctor of Medicine degree from The University of Iowa. He completed a 3 year Family Medicine residency at Broadlawns Medical Center affiliated with The University of Iowa, and has maintained Board Certification in Family Medicine since 1985. He has been married for over 30 years, and has three children and one grandchild.

 

 

Office Entrance – Suite #101

 

Attached here is information regarding Medicare preventive services.  Medicare does not cover a routine annual physical exam, and evaluation and management of health problems is not considered to be part of covered preventive services.

Medicare interactive chart

Medicare Preventive Services

Preventive service checklist

The ABCs of the Annual Wellness Visit