Forms

Please print and fill out the forms that is necessary to you and bring in completed to our office. Thank you!

New adult patients should fill out the Registration Form, the HIPAA/Financial Notice, and Release of Information.  New child/adolescent patients should fill out (or their parent/guardian should fill out in the child’s name) the Registration Form, the HIPAA/Financial Notice, Release of Information, and the Consent to Treat a Minor. If legal custody of the child is shared, both individuals must sign a Consent to Treat a Minor.

There may be additional forms, please check with your scheduling office.

Consent for Treatment of Minor

Consent for Treatment of Vulnerable Adult

HIPAA/Financial Notice

Registration Form

Release of Information

Español

Forma de Registro

HIPPA/Póliza Financiera

Consentimiento de Tratamiento para Menores de Edad

 

Referral Forms

Referral form can be completed by a healthcare professional, human services, probation, etc.

Mankato Referral Form