We have made all the necessary forms available for download/printing here on the web site for your convenience. These forms were designed in an Adobe PDF format. If you don't have adobe acrobat reader, you can download the free software using the link at the bottom of this page.
We have two categories of patient forms:
If you are under 65 years of age:
We require all patients under 65 years of age that are not on these insurances/coverages; Medicare, Medica, Workers comp, Auto claim, or Disability insurance, to call your insurance company and verify your health insurance benefits before your scheduled appointment. We now require this because of the amount of errors the insurance companies have been making quoting your benefits. We call your insurance to verify your insurance is active and in good standing, but we don't verify your actual benefits. We have put together an insurance verification packet for you so you know the correct questions to ask your insurance company and make sure all the services performed at NDBC are covered.
If you are over 65 years of age:
If you are 65 years of age or older or on these insurances/coverages; Medicare, Medica, Disability, Auto claim, or Work comp, we don't require you to verify your healh benefits before your scheduled appointment. We will verify your benefits before your appointment for you. Please fill out all the information in the patient packet below before your scheduled appointment.
If you have any questions while filling our these forms please call our office at 952-345-3000.
*Download Maps Here* - Click here To download a PDF document to all NDBC locations!
NEW PATIENT INFORMATION PACKETS - UNDER 65 YEARS OF AGE
1. Medical History Form
For an Adobe PDF document 
2. Dizziness Handicap Index (DHI)
For an Adobe PDF document
3. Health Insurance Verification Packet
For an Adobe PDF document
4. Patient Polices and waivers
For an Adobe PDF document
NEW PATIENT INFORMATION PACKETS - OVER 65 YEARS OF AGE
1. Medical History Form
For an Adobe PDF document
2. Dizziness Handicap Index (DHI)
For an Adobe PDF document
3. Patient Polices and waivers
For an Adobe PDF document
ORDER FORM FOR YOUR PHYSICIAN (if needed)
Referral Order form:
For an Adobe PDF document
RELEASE OF MEDICAL RECORDS WAIVER FORMS
1. Release Form - For Releasing Your Records To NDBC
For an Adobe PDF document
2. Release Form - For NDBC to Release Your Records To Another Clinic or Physician
For an Adobe PDF document
3. Release Form - Verbal Release For One Of Our Providers To Talk To Your Provider
For an Adobe PDF document
APPOINTMENT BROCHURES/INSTRUCTIONS
1. Brochure - Comprehensive Evaluation
For an Adobe PDF document, page 1 Page 2
2. Brochure - Audiology Balance Lab Evaluation
For an Adobe PDF document, Page 1 Page 2
3. Brochure - Physical Therapy Evaluation
For an Adobe PDF document, Page 1 Page 2
**NOTE: To print brochures:
1. Click on the link above to open the brochure image in a new window
2. After the brochure loads, right click your mouse
3. Select "save picture as", and then choose desktop as location to "save in" from the menu
4. Open the file from your desktop on your computer by double clicking on the file
3. Then choose the printer icon and follow the basic instructions to print brochure
 Click here to download Adobe Acrobat reader
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