Patient Forms and Policies

Patient Forms

English | Spanish | Interpreting Services

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

MANA Family Medicine

Northwest Arkansas Pediatrics

MANA Urgent Care

Millennium Chiropractic and Rehab

Northwest Arkansas Psychiatry

Renaissance Women’s Healthcare

The Breast Center 

Imaging & Health Services

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:

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. 


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Clinic Hours

See our clinics page for each clinic’s operating hours.


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.


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.