Forms
Below are some medical forms you might need. Please print and fill these forms out and bring them to your scheduled appointment. If you have any questions, please call to speak with our Health Information Management Team.
Forms
- Behavioral Consult Screening Questionnaire for Parents
- Change of Guarantor
- Change of Guarantor (18 years and older)
- Consent for Services and Financial Policy
- Consent to Communicate (18 years and older)
- Demographic Form
- Mental Health Consent to Communicate (under 18 years old)
- Mental Health Patient Questionnaire
- Minor Consent for Services (13-17 years)
- MSHSL Student Athlete Post COVID-19 Return to Sport
- Sports Qualifying Physical Examination Clearance *Please complete all questions on page 2 along with a parent signature prior to sending in your form
Contact Us
Health Information Management
Phone # 952-401-8265
Fax # 952-401-8242
healthinformation@slpeds.com
South Lake Pediatrics
Attn: HIM Department
17705 Hutchins Dr #250
Minnetonka MN 55345
