Patient Forms


Please arrive to your first appointment 15 minutes early for check in and insurance verification

Medical History Form  
This form should be completed by all patients, new and returning, for your first therapy appointment. Please print, fill out, and bring with you to your first therapy appointment.

HIPAA Form   
This form describes how health insurance information about you, as a patient of this practice, may be used and disclosed. This is required by the Privacy Regulations. Please print, sign, and bring with you to your first therapy appointment.

Cancel / No Show Policy
This form explains our policy on canceling or no showing for appointments. Please read prior to your first appointment.

Consent for Minors
This form needs to be completed by a parent or legal guardian if you are unable to accompany your minor for their first therapy visit. Please print, sign, and send with your minor to their first therapy appointment.

Medical Records Release Form
This form needs to be completed, signed, and returned for release of your medical records.


Physician Forms



Referral Pad
This form is available for physicians to download if they run out of referral pads.
If you are a physician and need more referral pads, please contact Kathleen Picard at 651-351-9264 or kpicard@therapypartners.com