fbpx

Patient Paperwork

The patient intake, consent to treat, and patient notice form below are to be completed by new patients.

Further down the page you will find the two release of information forms to be completed if you would like to send health records in or out of Integracare. 

All forms can be completed/submitted online, or they can be printed and brought into the office. 

Patient Intake Form

This paperwork asks about your symptoms that you will be seen for during your appointment.

Consent to Treat Form

This consent to treat must be signed prior to receiving care at the clinics. 

Privacy Policy

This notice applies to the medical records maintained by this office and it specifically details how your medical information may be used and disclosed to third parties. This notice also details your individual rights regarding your medical records.

Release of Information

Sending Records OUT of Integracare

To be completed when sending information from Integracare to another medical facility.

Sending Records INTO Integracare

To be completed when sending information to Integracare from another medical facility.

To be completed when sending information to Integracare from another medical facility.

integracare clinic foley

Phone: (320) 968-7234
Fax:
(320) 968-7237
Email:
info@integracareclinics.com
Clinic Hours: Monday – Friday 7am-5:30pm

Copyright [year], Integracare LTD, All Rights Reserved. Information on this website should not be regarded as medical advice.

CONNECT WITH US