PATIENT FORMS - TWIN CITIES AREA

Please read, sign, and bring the following forms with you to your upcoming appointment:

• Patient Financial Policy
• HIPAA Privacy Acknowledge Form

To request your medical records please fill out the form below, when finished please fax to (952) 920-3225 or email to contact@edinaeyeclinic.com:

• Records Authorization Form

The following document is our Notice of HIPAA Privacy Practices:

• Notice of Privacy Practices

• Online Patient Registration