Patient Forms
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Many forms are now available to complete securely on the myMANA health portal.
Login to myMANA to complete forms online
If you prefer to download forms, you can find them on this page.
Fayetteville Diagnostic Clinic
- Internal Medicine New Patient Packet
- Pulmonary Medicine New Patient Packet
- Rheumatology New Patient Packet
- Sleep Medicine Questionnaire
- MANA North Hills Campus Map
MANA Family Medicine
- Adult New Patient Packet (fillable form)
- Adult New Patient Packet (printable)
- Child New Patient Packet (fillable form)
- Child New Patient Packet (printable form)
Northwest Arkansas Pediatrics
MANA Urgent Care
Millennium Chiropractic and Rehab
- Millennium Chiropractic New Patient Packet
- At-Home Exercises – Ask your doctor for the password
Northwest Arkansas Psychiatry
- NWA Psychiatry Adult New Patient Packet
- NWA Psychiatry Child New Patient Packet
- TMS New Patient Packet
Renaissance Women’s Healthcare
The Breast Center
Imaging & Health Services
- MRI New Patient Packet (Includes Appointment Prep your physician may complete)
- Bone Density Preparation
- Pulmonary Function Test Preparation
- MANA North Hills Campus Map
Patient Policies
Financial Policy
We accept most major insurances, including Medicare and Medicaid. You should have your insurance card available at all appointments. Payment for copays, coinsurance, and deductible is due at the time of service. We accept cash, checks, and debit/credit cards (Visa, Mastercard, AMEX, and Discover).
Nondiscrimination Policy and Services
Discrimination is against the law. Medical Associates of Northwest Arkansas (MANA) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. MANA does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. At MANA clinics we provide:
- Free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreter
- Written information in other formats (large print, audio, accessible electronic formats, other formats)
- Free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information is written in other languages
More information on our Nondiscrimination Policy. If you need these services, please let us know.
Privacy Policy and Your Medical Records
A medical request signed by the patient is required to send or release records to anyone. To request your medical records, download a record release form and return it to our office.
- Our Privacy Notice
- Authorization to Individuals (Allows you to share your medical record with your spouse, family member, or friend)
- Record Release Form
- Request for Restricted Private Health Information (PHI)
- Request for Amendment to Protected Health Information
- Privacy Incident Report
Survey
Take our Survey – How was your experience at MANA?
Clinic Hours
See our clinics page for each clinic’s operating hours.
Holidays
MANA Clinics are closed New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving (Thursday and Friday), and Christmas Day. MANA Urgent Care will have one location open on Memorial Day and Labor Day.
Inclement Weather
Please check local television stations and MANA social media for announcements regarding clinic closures due to inclement weather. Patients should call the clinic before coming in during inclement weather.
Emergencies
In case of an emergency, please call 911 or go to your nearest hospital emergency room.
24/7 Care
If you have an acute medical problem that cannot wait until the clinic is open, MANA has Urgent Care Clinics. If you need to reach a provider after hours, please call 479.463.1000 and ask to speak to the physician on call.