Patient Forms

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.

Authorization for Treatment
This form should be completed by all patients, parents, or legal guardians of minor patients. Please print, initial, 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
If you are requesting a copy of your medical records, please complete this form and fax or mail as instructed on form. For specific questions, call (651) 747-4339 or (651) 747-4341.

Physician Forms