Appointment Checklist

We look forward to seeing you at your upcoming appointment. 
The checklist below can help you prepare.

Bring the following: 

  • A completed medical history questionnaire 
  • Medical histories related to the reason for your visit
  • Copies of relevant tests and x-rays
  • A list of all medications taken on a regular business, including over-the-counter and herbal medicines.  

Review any special directions from your doctor regarding diet or medication restrictions.

Depending on the type of appointment you have, you may wish to arrange for a ride home. 

Payment Plan

For your convenience, use this secure form to request a payment plan for Northwest Family Clinics PA.

Financial Policy

Click to download the form: Patient Financial Policy

Billing and Insurance

How do I know if you accept my insurance?

We accept many insurance plans, but cannot guarantee their coverage of our services. You are responsible for verifying coverage and benefits of their individual policy. It is best to contact your insurance company directly by calling member services (number is usually listed on the back of your insurance card).

Why do I have to show my insurance card at each visit?

By showing your insurance card at each visit, you insure that Northwest Family Clinics has the most up-to-date information for efficient and accurate billing. For example, sometimes employers change the group number but the ID number stays the same. Inaccurate or expired insurance information can cause issues when processing your insurance claims.

Why do you need a copy of my photo ID?

We require a copy of your photo ID to help prevent insurance fraud.

I have insurance. Why did a get a bill?

Covered services vary from plan to plan. Additionally, most plans have copays, coinsurance, or deductibles which will impact the amount you owe. We submit your bill to your insurance plan for services provided. Your insurance plan determines the amount they will cover and the amount that is your responsibility. Any portion of the charges that your insurance plan does not cover is the amount that is your responsibility.

What is the difference between a copay and coinsurance?

A copay is a flat amount that you pay each time for certain services. For example, you may pay a $25 copay for each office visit. Coinsurance is a percent of a covered benefit. For example, a visit covered at $100 with a 20% coinsurance. You would pay $20 and your insurance would pay $80.

What is a deductible?

A deductible is the amount your insurance plan requires you to pay out-of-pocket before coverage begins. Deductible amounts vary from plan to plan.

If I don’t have insurance, can I still be seen?

Yes. However, if you do not have insurance you will be asked to pay at the time of service. For patients without insurance, Northwest Family Clinics offer a 20% discount if paid in full at the time of service.

Can I be billed for my copays?

We are not able to bill you for your copays. The contracts we sign with insurance companies require us to collect copays at the time of service.

Who should I call if I have questions about my bill?

Northwest Family Clinics has a central Business Office located in Crystal. 
You may dial them directly at (763) 504-6550. 

A Business Office Representative is available to answer your questions Monday - Friday 8:00AM - 4:00PM.

Request Health Records

How do I request a copy of my medical records?

Click to download the form below and return to your preferred location:

Medical Record Release Authorization

How do I transfer medical records from my previous provider?

Please contact your previous health care provider to request that they transfer your records to us.