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 19% discount. If you’re having trouble making payments on your account, please consider filling out our financial assistance application.
Note: If you filled out Essentia Health’s financial assistance application and were approved within the past year, we’ll recognize and accept it. Simply provide a copy of the award letter to us and the same discount will be applied to your Duluth Family Medicine Clinic account. If you’ve previously been awarded financial assistance through St. Luke’s, we encourage you to fill out our application as well.
- 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.