Patient Forms

Appointment Forms (Required)
Specialty Forms
Additional Forms

Appointment Forms

Required for all new patients,
or returning patients whose most recent appointment was over 3 years ago

General Consent Form
Patient Demographic Form

Choose one of the following options:

Health History Form - Healow Login Required
Health History Form - No Login Required

Specialty Forms

Prenatal Health History Form
Nuerogenic Bladder Questionnaire

Additional Forms

Release of Medical Records - From Pediatric Surgical Associates

Release of Medical Records

Release of Medical Records - To Pediatric Surgical Associates

According to Minnesota law and the HIPPA privacy rule, when patients turn 18 years old they are considered adults, and parents and guardians can no longer access the patient’s medical information without the child’s written consent. Please have your child fill out this consent form if they would like to provide consent for you (or anyone else) to view their medical record.

‍ ‍18+ Medical Consent Form

18+ Medical Consent Form

If someone other than the patient’s legal parent or guardian will be bringing the patient to the appointment, this form must be completed and signed by the child’s legal guardian prior to the appointment.

Temporary Consent to Accompany a Minor

Temporary Consent to Accompany a Minor Form


To send our office proof of legal guardianship, custody, adoption documents, foster care documentation, or related forms, please submit using the link below:

Proof of Legal Guardianship

Submit Legal Guardianship Documentation