Forms

Please print and fill out the forms that is necessary to you and bring in completed to our office. There may be other paperwork for you to complete; please check with the office manager at the location where you will be seen.

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

 

Referral Forms

Referral form can be completed by a healthcare professional, human services, probation, etc., and returned via fax to 855-847-9876.

Mankato Referral Form