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Patient Forms

We have made all the necessary forms available for download/printing here on the web site for your convenience. These forms were designed in an Adobe PDF format. If you don't have adobe acrobat reader, you can download the free software using the link at the bottom of this page. If you are a new patient at PDR you will need to download/print the following forms prior to your first appointment.

♦ Health History

♦ Health insurance benefit worksheet

 

If you have any questions while filling our these forms please call our office at 952-908-2700.

 
To learn how Physicians' Diagnostics and Rehabilitation can help you lead a better life, email or call us at 952-908-2700.
Patient Forms

Health History

Notice of privacy practices

Patient payment policy

Health Insurance Benefit Worksheet

Consent Form to Release Health Information

Patient consent form

Patient complaint form

Adobe Acrobat Reader is required to view these forms. Click here to download Adobe Acrobat Reader

Copyright © 2011 PDR Clinics.
All Rights Reserved.

Physicians' Diagnostics & Rehabilitation (PDR) specializes in the non-surgical treatment of neck and back pain. A clinic with a focus on medical expertise in the treatment of neck, upper and lower back pain. We serve individuals throughout the Twin Cities area. This includes Minneapolis, St. Paul, Bloomington, Edina, Burnsville, Apple Valley, Eden Prairie, Chanhassen, Minnetonka, Coon Rapids, Anoka, Blaine, Maplewood, Roseville and White Bear Lake, Minnesota (MN).