Information Directory

Are you taking any medications (prescription or over-the-counter), vitamins, herbal supplements, etc.? If so, please fill out our Patient Medication Record and bring it to your next office visit.

Consent to Treat a Minor

HIPAA Notice of Privacy Practices

Medical Records Release of Information

Patient Medication Record

Patients under 18 must be accompanied by a parent or guardian. If a parent or guardian cannot be present, this consent form must be signed before the patient can be seen.

FORMS

In order to serve you better, please review our forms and visit information.

To help protect your identity, and ensure accurate medical chart documentation, at every visit you will be required to present a current Photo ID and current Insurance Card at the front desk.

You may be asked to update your Patient Profile and/or fill out various surveys for quality assurance purposes.


You may be asked to update your Patient Profile and/or fill out various surveys for quality assurance purposes.



Existing Patients

Please bring to your appointment​:


  • ​​Photo ID
  • Insurance information and card(s)
  • A list of your current medications, including vitamins, supplements and over-the-counter medications (if changed from your last visit)
  • List of questions/concerns you wish to address with your Provider



New Patients

​please bring to your appointment:


  • Photo ID
  • Insurance information and card(s)
  • Your current medications, including vitamins, supplements and over-the-counter medications
  • Information about what treatment(s) and medication(s) have been tried in the past
  • Medical records from prior visits that you think may be helpful
  • List of questions/concerns you wish to address with your Provider

In order to serve you better, please review our forms and visit information.

Patient Forms for Download

Clinic Hours / Appointments


Monday-Friday: 8:00am - 5:00pm


​Appointments:  651-653-0062


DISCLAIMER:

As you explore our website you will find links to various external websites which provide additional medical information, medication guidelines, and other helpful resources. AALFA is not responsible for the content of those websites, and does not assume that their content will adhere to the same values practiced in our clinic.

We take your privacy very seriously. Our clinic is committed to complying with all HIPAA regulations, which are designed to safeguard your personal medical information. Please reference the HIPAA Privacy Notice, above, for detailed information on how we protect, use and disclose your personal health information.


HIPAA Receipt / Financial Responsibility Agreement

VISIT INFORMATION

Getting Ready for Your Visit

Forms & Visit Information

Our Patient Information Packet has been compiled as a resource to provide our patients current information about HIPAA Privacy regulations, our clinic policies regarding Medication Refills, Billing and Insurance, Protection Against Medical Identity Theft, and more about the care we provide at AALFA Family Clinic.

Please reference this packet for any questions you may have regarding the care you receive at AALFA Family Clinic. 



*All documents are the property of AALFA Family Clinic and may not be edited, amended or reproduced without express permission of AALFA Family Clinic.

While we do accept most major health insurance plans, we cannot guarantee your insurance will cover our services. It is the patient's responsibility to contact their member services prior to their visit to verify eligibility and benefits.

The patient accepts ultimate responsibility for payment, regardless of insurance coverage or payment problems.


  • Copays are due at the time of service.
  • We accept cash, checks, VISA, Discover and MasterCard.


Visit our Billing & Insurance page for more information.

Urgent Care / After-Hours Care


We offer same day appointments during regular clinic hours for Urgent Care.

After-hours our doctors are on-call through our answering service:

651-653-0062.

Existing Patients

New Patients

Insurance/Payment Information

Patient Information Packet

Travel Consults and Shots