Forms & Visit Information

 

Getting Ready for Your Visit:

In order to serve you better, please review our forms and visit information. At every visit you will be required to present a current Photo ID and Insurance Card at the front desk. You may be asked to update your patient profile and/or fill out various surveys for quality assurance purposes.

New Patients, please bring to your appointment:

  • Photo ID
  • Insurance information and card
  • A list of your current medications
  • Information about what treatments and medications have been tried in the past
  • Medical records from prior visits that you think may be helpful

Existing Patients, please bring to your appointment:

  • Photo ID
  • Insurance information and card
  • A list of your current medications (if changed from your last visit)

 

Financial Information:

Copays are due at the time of service. We accept cash, checks, VISA, Discover and MasterCard. While we do accept most major health insurance plans, it is the patient's responsibility to contact their member services prior to their visit to verify eligibility and benefits. Please contact our billing office at 763-398-5233 should you have any questions regarding your bill.

Traveling out of the country? Be sure you are up-to-date on your regular immunizations. You may need a physical exam and additional vaccinations depending on your destination. Specific travel shots are administered at local travel clinics. Read more...

 

Patient Forms for Download:

*All documents are the property of AALFA Family Clinic and may not be edited, amended or reproduced without express permission of AALFA Family Clinic.

    • Our Patient Information Packet has been compiled as a resource to provide our patients current information about HIPAA Privacy regulations, our clinic policies regarding Medication Refills, Billing and Insurance, Protection Against Medical Identity Theft, and more about the care we provide at AALFA Family Clinic.
  • Are you taking any medications (prescription or over-the-counter), vitamins, herbal supplements, etc.? If so, please fill out our Patient Medication Record and bring it to your next office visit.
  • Consent to Treatment of a Minor - Patients under 18 must be accompanied by a parent or guardian. If a parent or guardian cannot be present, this consent form must be signed before the patient can be seen.
  • Release of Medical Information / Records: Please print and sign the appropriate form if you wish to have records transfered to or from our clinic, or if you wish a personal representative or family member to have access to your health information.