Save time when you register as a new patient. You can fill them out in the comfort of your home and bring them with you to your appointment.
- Auto Accident form (PDF)
- Financial Assistance Application (PDF)
- Health History form (PDF)
- My Medication List (PDF)
- Patient Information & Authorization form (PDF)
- Parental / Guardian Consent to Treatment of a Minor (PDF)
- Release of Medical Information (PDF)
- Worker’s Compensation Claim (PDF)
- Authorization to Discuss your Health with Others (PDF)
What to Bring to Your Appointment
- Insurance cards
- Picture ID
- Medical records (You may be asked to sign a release of information to get old medical records.)
- Medication bottles or a list of your medications
- Guardianship papers (if you have them)
- Medical power of attorney information (if you have one)
- Advanced care directive (if you have one)
We mail billing statements each month. Your statement will list:
- Services provided at your visit
- Charges submitted to your insurance company
- Payments we have received from the insurance company, if any
Patients Without Insurance
If you don’t have insurance, your account will be considered self-pay. If you pay for your medical services in full the day of your visit, you will get a 25% discount. If you’re having trouble making payments on your account, please consider filling out our financial assistance application.
Note: If you have previously been awarded financial assistance through Essentia Health or St. Luke’s, you will still need to complete an application for Duluth Family Medicine Clinic.
- Pay your bill online as a MyHealth guest. You will need the guarantor number from your bill.
- Pay your bill online as a MyHealth member and log in.
Your family medicine doctor may decide you need to see a specialist. Your insurance company may require a referral first. Please contact your insurance company to verify needed visits, services, and providers are covered. If you have questions regarding referrals, call 218-529-9144.