Dr. John Knutson has retired. We are no longer excepting patients. THE PRACTICE IS NOW CLOSED. This is the most up-to-date information at this time.
If you have submitted your “Records Request/ Patient Disclosure” form to our office, you will be contacted shortly by our office staff to discuss further action regarding your patient information/ medical records. If you were contacted prior to this announcement, please call our office directly so our office staff can pull your medical information from our system. Thank you for your understanding.
Patient Intake forms (PDF Version): You must be compatible with the system we have in order to correctly print out these forms, as we have intended. Our systems are: Adobe Reader 6, version 11.0.12 and Microsoft Office 2010, version 14.0.
If you are not compatible with these versions or do not have the correct layout of our forms, please contact us immediatley.
Please note: The number that is listed next to the forms are a reference to how many pages there are in that section. Please make sure you have all of the pages printed and filled out before arriving to your appointment.
You may release your records to yourself, parents/guardians (if a minor), or another physician. To do this, please write where you would like your records to be sent by filling out the release of medical information form below.
If you are releasing these records to yourself, put your name and information in the “release information to” slot.
If you are releasing your records to another physician, put the name of the physician in the “release information to” slot.
- Demographics / HIPAA Form (2 pages total)
- Patient History Form (5 pages total)
- Office Policy Form (3 pages total)
- Release of Medical or Billing Information/ RECORDS RELEASE (1 page total)
If you are a legal guardian/ foster parent of the patient, please bring all legal paperwork regarding the patient to the initial appointment.
If you are an ESTABLISHED PATIENT and are being seen as a follow- up, please contact our office at 928-774-1700 to verify which forms to fill out.
NEW PATIENT APPOINTMENTS MUST BE CONFIRMED.