(651) 288-3098


Contact Information

Minnesota Pain Relief & Wellness Institute


2151 Hamline Ave N, Suite 111

Roseville, MN 55113

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Online Forms

To make your first visit more efficient, Minnesota Pain Relief & Wellness Institute offers our new patient forms available online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click HERE.
  • Download the necessary forms, print it out and fill in the required information.
  • Bring your completed forms with you to your appointment or you can fax your forms to (651) 288-3981 prior to your visit.

New Patient Health History Form - Required

This lets us know your health history and elaborates on current issues. What questions, concerns, and goals can we help you with?

 Download & Print Form


Notice of Privacy Practice Form - Required

We want you to know that we value your privacy. As part of the federally mandated HIPAA act, we are required to have all patients review and acknowledge that they have been informed of our privacy compliance practices. (If you would like to review our complete "Notice of Privacy Practices" click HERE.)

 Download & Print Form


Open Therapy and Adjusting Room/ Records Release Form - Required

Adjustments, active care, and therapies are delivered in an open setting; this makes much more effective use of the time you spend in the office. This form delineates the efforts we make to keep your care private. The bottom of the form is an information release that allows us to share your information to get your bills paid and in other specific situations.

 Download & Print Form


Personal Injury Collision Form – Only needed for those injured in a Car Accident

If you have been involved with an accident involving a motor vehicle, there are many more questions relevant to your care that we want to ask. To simplify this process, you will want to complete this form prior to your visit as well.

 Download & Print Form

Office Hours

Mon 11:00 - Noon Noon -7:00 PM
Tues 6:30 - 11:30 AM 3:00 - 7:00 PM
Wed 6:30 - Noon Noon - 3:00 P
Thurs 6:30 - 11:30 AM 3:00 - 7:00 PM
Fri 6:30 - 11:30 AM  
Sat 8:00 - 11:00 AM