Patient Forms

In preparation of your appointment, you may be asked to complete some or all of the forms listed within the Pediatric or Adult sections below.

Note: All the forms below are posted in PDF file format. You will need the free Adobe Acrobat Reader software to view and print out these forms.

Medical Records Release Information and Release Form

Copies of medical records are available from Minnesota Epilepsy Group’s Medical Records Department. We take every precatuion to pretect the rights and privacy of our patients. To ensure the privacy of patients and their families and to comply with federal regulations, parents or guardians must sign an authorization form for releasing information. Processing of the request can take up to five working days or more.

Patient, parent and legal guardians have legal right to information about a patient’s care. Federal and state laws provide for the ability to obtain copies of medical records for a reasonable fee. Minnesota Epilepsy Group supports your legal rights and gives you access to the medical record free of charge.

Our Medical Records Department is open M-F 8:00a – 4:30p. Contact us by phone or mail.

Phone: (651) 241-5287
Fax: (651) 241-5320

By mail:

Minnesota Epilepsy Group
Attn: Medical Records Department
225 Smith Ave N., Suite 201
St. Paul, MN 55102

For New Pediatric Patients

For New Adult Patients

For New Neuropsychology / Psychology Patients

Additional Contact Info for Patient Portal

For Patients with a Court Appointed Guardian

Federal privacy laws require that we have proof of the current guardian/conservator’s identity in the patient medical record. we need you to send us a copy of the court order appointing you as the patient’s legal guardian/conservator. this ensures the patient’s privacty because it restricts who has access to his/her medical record.

Seizure Calendar

Minnesota Driver Vehicle Services

To obtain more information about testing or neuropsychological evaluations, click on either of the following links – you will be redirected to a different website.

Minnesota Epilepsy Group has also provided you with information on our privacy practices and collection policies for your review.

Find a map and directions on the Contact us page.

https://www.mnepilepsy.org/megoldsite/patresources/seizcalendar.pdf