Edina Family Physicians

24 Hour Phone: 952 925 2200

 

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New Patient Forms
  Click on the blue document link to open and print.


         *  PATIENT INFORMATION: The Patient Information form is demographic information by needed by Edina Family Physicians,
         for identification purposes, insurance and billing information.  This document needs to be filled out by New Patients or
         existing patients with a Change Of Address.


         The Forms below are given to all patients - click on each of these for a description of each form.
         The "Consent" forms below are not for requesting records -
          please see the Release of Information Form at the bottom of the page if you need records
.


         *  ASSIGNMENT OF BENEFITS
         *  CONSENT FOR RELEASE OF INFORMATION
         *  CONSENT FOR RELEASE AND COMBINING OF HEALTH RECORDS AMONG HEALTH CARE PROVIDERS

EFP   |  Allina  

Medical Records Release Form
Fax All requests to 612-262-2323

Copyright 2019 | EDINA FAMILY PHYSICIANS Affiliated with AllinaHealth

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