Appointment Scheduling: 763.587.7999 • General Information: 763.587.7900

Patient Information

Patient Information Forms (Adobe Reader is needed to view this document.)

Permission to Verbally Discuss PHI Form

Patient Acknowledgement Form

Electronic Health Exchange Consent Form

Please print and complete these information forms. We ask that you bring the completed form and your current insurance card with you to your appointment.

If you have questions, please call our Business Office: (763) 587-7811

Health History Questionnaire

Health History Questionnaire (Adobe Reader is needed to view this document.)

Please print and complete this Health History Questionnaire. We ask that you bring the completed form with you to your appointment.

Authorization for Release of Information Form

Authorization for Release of Information Form (Adobe Reader is needed to view this document.)

If you need the release of your medical information, please print and complete this form.  You may deliver the completed form to the facility from which you are requesting your medical information.

If you have questions, please call Medical Records: (763) 587-7943

If you do not have Adobe Reader installed on your computer and you want to install it, please visit the Adobe website.

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