Health history form New patient form

           

Thank you for choosing our clinic to assist in your care. It is important that you arrive 15 minutes prior to your appointment time. As a courtesy to our allergy sensitive patients and staff we request that you do not wear fragrance to your appointments.

 

Please print the registration and health history form and complete it to establish you as our patient. It is important that you answer all of the questions and provide us with all the information requested. Please return the completed forms at least one week prior to your appointment. You may fax or mail the form to us.

 

We encourage you to contact your primary care physician or referring physician as soon as possible to either obtain a copy of your pertinent medical records or have a copy sent to us. It is important that your records are available at the time of your appointment.

 

At your visit(s) please have your insurance card(s), referral information, and copay ready.  Please provide these things to the receptionist when you check in.

 

If you have questions regarding your appointment, please call our front desk at  (952) 893-1959. If you have questions regarding your insurance coverage please contact your insurance company.

 

We look forward to seeing you!