You may fill out the form below and submit electronically and fax patient records to 763-427-4643. Alternatively, you may also download and print this document, and then fax it to 763-427-4643 along with patient records.

    Refer a Patient

    If this is an emergency, please call our office: 763-427-1137

    Or Fax this form to: 763-427-4643