Patient Information

Dr. Bender accepts all PPO and POS insurances, as well as Medicare.

Dr. Bender is also a provider for Providence Care Network.

Patient Forms

The following forms can be downloaded and printed at home to be filled out prior to your office visit. This will save you time during your first office visit.

Please print out and complete the appropriate forms:

• Patient Information Form
• HIPAA Privacy Form
• Advanced Beneficiary Notice (ABN) form
• Blood Draw Fee Form
• Acknowledgement of Financial Responsibility Form