Form Submitted!
Thank you for completing an Authorization for Release of Information (ROI). Your submission has been received.
ATTENTION: You will need to complete a separate ROI for EACH different clinic/location where you have received treatment or services for your current condition. If you need to fill out another ROI, click the link below to return to the form.
ADDITIONAL DETAILS
If you would like a copy of your completed paperwork, please contact us and request one:
- 952-841-2345, option 3
- referrals@tcpain.com
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Here is some helpful information to know before you go:
"I can now do activities I hadn't been able to in years. Thank you Twin Cities Pain Clinic!"
-K. Jones
"I've been nothing short of absolutely happy with my care at Twin Cities Pain Clinic."
- A. Halford
"The staff at Twin Cities Pain Clinic really listen to me and treat me as an individual."
-K. Caplinger
