Click on the blue document link to open and print.
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
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 -
the Release of Information Form at the bottom of the page if you
ASSIGNMENT OF BENEFITS
CONSENT FOR RELEASE OF INFORMATION
CONSENT FOR RELEASE AND COMBINING OF
HEALTH RECORDS AMONG HEALTH CARE PROVIDERS