Contact Us

We're ready to help!

A black background with a white circle in the middle.

We STRONGLY encourage you to use the patient portal for the fastest and easiest communication with our clinic.

If you would like access to My Chart, please email [email protected] with the following information FOR ALL PATIENTS you would like setup with portal access: 1-The first and last name and 2-The date of birth.

If you need to submit a form please use the email [email protected]

 

To schedule an appointment, call us at 952-999-0333 and we will be happy to assist you in making your appointment.

A black background with some white dots on it
Fill the form
A black background with a white circle in the middle.

Different Question?

Fill out this form:

Name(Required)

We're always ready for a call!

Phone:  (952) 999-0333

Fax:  (952) 300-2558

Contact Us

Employment Application

Fill Out the Form Below!

Name(Required)
Address(Required)
Are you over the age of 18?(Required)
Are you legally allowed to work in the U.S.?(Required)
Desired type of employment(Required)
Are you able to work weekends?(Required)
Highest level of education received(Required)
Max. file size: 1 GB.
Upload your resume here

Request Employment Verification

Fill out the form below

Please enable JavaScript in your browser to complete this form.
Click or drag a file to this area to upload.

Address Change

Change your address by filling out the form below:

Please enable JavaScript in your browser to complete this form.
New Address

Personal Info and w-4 Upload

Company Holidays (Office Closed)

  • New Years Day
  • Easter
  • Memorial Day
  • Independence Day
  • Labor Day
  • Thanksgiving
  • Christmas Day

$250 Employee Healthcare Benefit

For information regarding your $250 EE healthcare benefit and how to use, please contact Emily Walters who will assist you through the process. [email protected]

W-4 Forms

If you need to download and print the W-4 forms, please click here to view and print.

https://www.irs.gov/pub/irs-pdf/fw4.pdf

https://www.revenue.state.mn.us/sites/default/files/2022-01/w-4mn.pdf

If you have filled out both your Federal and Minnesota W-4 form and are ready to submit, please attach the form now.

Update your W-4 by filling out the form below:

Please enable JavaScript in your browser to complete this form.
Click or drag a file to this area to upload.

InterPreter Request

Please Give Two Weeks Notice For Interpreter Request

Please enable JavaScript in your browser to complete this form.
Date / Time the Interpreter is Needed

401K Enrollment Form

Please complete the employee sections of the enrollment form found at this link. Click here.

Once you have completed the form, please attach and submit for processing.  You will be notified once your account is setup.

Here are some things to keep in mind:

Please enable JavaScript in your browser to complete this form.
Click or drag a file to this area to upload.

Direct Deposit

Use this form to setup or update your Direct Deposit information. Contact Karissa at [email protected] with any questions.

Please enable JavaScript in your browser to complete this form.
Name of Financial Institution
Account Type
Click or drag a file to this area to upload.
Name of Financial Institution
Account 2 Type
Click or drag a file to this area to upload.

Submit W-4 Info

W-4 Forms

If you need to download and print the W-4 forms, please click here to view and print.

https://www.irs.gov/pub/irs-pdf/fw4.pdf

https://www.revenue.state.mn.us/sites/default/files/2022-01/w-4mn.pdf

If you have filled out both your Federal and Minnesota W-4 form and are ready to submit, please attach the form now.

Please enable JavaScript in your browser to complete this form.
Click or drag a file to this area to upload.

Payroll Setup Form

Please enable JavaScript in your browser to complete this form.
Address

New Hire Request Form

Use this form to make a new hire request. If you have any questions, please contact [email protected].

Please enable JavaScript in your browser to complete this form.
Click or drag a file to this area to upload.

Legal

Please describe the situation and submit for Jeffrey to review. If you have questions, please contact Jeffrey at [email protected]

Patient Complaints

Please provide the following information and we will follow up on the complaint. If you have any questions, please contact Karissa Lucas at [email protected]

Technical Support Ticket

Please enable JavaScript in your browser to complete this form.
Issue / Request Type

Lab Supply Order

Please complete the following information to have your lab supply order processed. If you have any questions, please contact Shelly at [email protected]

Please enable JavaScript in your browser to complete this form.
Click or drag a file to this area to upload.

Supply Order Request

Please use this form to place a supply order request. Contact Sara at [email protected] with any questions.

Please enable JavaScript in your browser to complete this form.
Click or drag a file to this area to upload.

Maintenance Request

Please provide the following information and Jeffrey will be in touch with you shortly regarding your request.

Please enable JavaScript in your browser to complete this form.
Click or drag a file to this area to upload.

Fill Out Your Records Request Below

Fill in all relevant info below and someone from our office will be in touch with you.

Name(Required)
Max. file size: 1 GB.

Fill Out Your Form Request Below

Fill in all relevant info below and someone from our office will be in touch with you.

Name(Required)
Max. file size: 1 GB.

Fill Out Your Billing Request Below

Fill in all relevant info below and someone from our office will be in touch with you.

Name(Required)
Max. file size: 1 GB.