Welcome. This section of the site provides many of the forms that our staff or other providers might ask you to complete before an appointment. If you have any questions, please feel free to call us at (612) 871-1145.
Forms to Request Records
Release of Information Form - from MNGI to other entity (electronic form)
Release of Information Form - from other entity to MNGI (electronic form)
Release of Information Form - CARE Counseling Release of Information (electronic form)
Health History / New Patient Forms
Patient Health History Form (electronic form)
Dietitian Advance Beneficiary Notice - ABN (electronic form)
Forms for Health Psychology Services
Informed Consent Form - Clinical Hypnosis
Adult Patient Authorization Form
Pediatric Authorization Form
Unaccompanied Minor Patient Authorization Form - For Clinic Use Only (electronic form)
Financial Assistance Application
Forms for Referring Providers