Schedule an Appointment

To make your genetics appointment, call Shana Wiley, Registered Nurse, at (701) 777-4277.

You will be asked a variety of questions, some of which may include the following:

• Patient's name, sex, date of birth
• Patient's biological parents' names and/or adoptive parents' names
• Legal guardian's name and address
• If applicable, name of foster parents and their address
• Addresses and phone numbers of those involved with the patient
• We will ask the reason for referral and require the primary care physician to send our office a written referral for the patient's chart
• Referring physician and their address
• Name of insurance
• We will be requesting records from medical providers, such as clinics, hospitals, doctors, and specialists
• We will be requesting (if applicable) school records such as IQ testing, developmental evaluations, IEP's/504's, and infant development
• If you are being seen for genetic counseling regarding pregnancy, we will need both partners' family history completed and returned to our office.

The required forms needed for your appointment are listed below and are available for you to download by clicking on them. Please return them as quickly as possible to our office.

• Release of Information Form
• Solicite Para la Liberación de Información
• Billing Form
• Family History Form
• Historia de Familia
• Prenatal Development of Patient who is a child
• Birth History of Patient Seen

Other forms for families with children who have special needs:

• Application for Health Care Coverage for Children, Families & Pregnant Women (North Dakota Department of Human Services)
• Application for Assistance (SFN 405) (Medicaid coverage + economic assistance programs)
• Children with Medically Fragile Needs Application