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.

Patient Notice Form

This notice must be signed prior to receiving care at the clinics. This is our HIPAA paperwork.

Sending Records INTO Integracare

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

Sending Records OUT of Integracare

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

471 MN-23, Foley, MN 56329

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

About Us

PATIENT PAPERWORK

PATIENT PAPERWORK

Patient Intake Form

Consent to Treat Form

Patient Notice Form

Sending Records INTO Integracare

Sending Records OUT of Integracare

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