Welcome to Valley Medical & Wellness! All patient forms can be completed online or printed and filled out by hand.
Before scheduling an initial consultation, please complete our New Patient Packet. For Chronic Pain Management consultations, please complete the Release of Information Form for any medical clinics you have attended within the last 12 months regarding your pain concern 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.
Select the button below to complete the form online:
Referrals for Pain Management require at least the most recent visit note (last 3 and imaging preferred).
Please use Patient Referral Form below.
Referrals can be emailed to email@example.com or faxed to 612-444-9000.
Our mailing address is 2428 E. 117th St., Burnsville, MN 55337.