Client Forms

Please fill out the new client paperwork below as requested. You may download the PDF version of the form, save it on your computer, fill it out, and upload the completed document using our upload tool. We recommend accessing the documents in Adobe Acrobat Reader (download here for free). Or, for those that apply, you may complete the online form and submit. For questions, please contact our Outpatient Therapy Services department at (612) 706-5592 or email rehabclinic@actg.org. Please print completed documents for your personal records.

Health History Form
Complete online form
Download PDF / Upload form

Educational Release of Information
Download PDF / Upload form

Medical Release of Information
Download PDF / Upload form

Medical Assistance Non-Coverage
Download PDF / Upload form

Insurance & Service Authorization
Complete online form
Download PDF / Upload form

Client Rights & Responsibilities
Complete online form
Download PDF
/ Upload form

Cancellation Policy
Complete online form
Download PDF / Upload form

Notice of Privacy Practices
Complete online form
Download PDF / Upload form

Photo Release
Complete online form