Patient Forms


patient forms

Welcome to Valley Medical & Wellness! Before scheduling your initial consultation, please complete our New Patient Packet, below. Additionally, please complete the Release of Information Form for all medical clinics you have attended within the last 12 months and collect any imaging results, such as MRI, XRay, or CT films. This will help expedite your appointment and maximize your time with our providers. You may also complete these forms electronically via our secure messaging app in the lower right corner of the website.

Forms can be emailed to or faxed to 612-444-9000. Our mailing address is 2428 E. 117th St., Burnsville, MN 55337.

open new patient packet  >
open release of information form  >
open patient referral form  >

Our Locations

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Fax Number: 612-444-9000