Are you experiencing Covid-19 symptoms? If so, please call the clinic before coming in! Face masks are required.

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Plymouth

Downtown Minneapolis

Pay Online Link

Forms

First Visit

Please read and fill out the following forms before you come in for your first visit:


1. New Patient Registration

Online Form or Print Document (pdf)


2. Health History

Online Form or Print Document (pdf)


3. Dear Patient

Online Form or Print Document (pdf)


4. Medication Reminders

Online Form or Print Document (pdf)


5. Notice of Privacy Practices

Online Form or Print Document (pdf)


6. Authorization for Release of Protected Health Information

Online Form or Print Document (pdf)


7. Patient Authorization for Proxy

Online Form or Print Document (pdf)


8. Headache Assessment (optional)

Only if coming in for headache

Online Form or Print Document (pdf)


 

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Allergy & Asthma Specialists, PA