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Appointment Request with Dr. Lund
Clinic: 14101 Fairview Dr, Suite #300, Burnsville, MN 55337
Area of the body:
*
Please Select
Ankle or lower leg
Back
Elbow
Foot
Hand
Hip or upper leg
Knww
Neck
Shoulder and upper arm
Wrist or lower arm
Treated at Summit Orthopedics before?
*
Please Select
New patient
Current patient - New problem
Current patient - Same problem
What side is the problem on?
*
Please Select
Left
Right
Both
Any MRI, X-Ray, CT, or nerve test (in the last 2 years) on this body part?
*
Please Select
None
Allina Health
HealthPartners - Regions, Methodist or Westfield
M Health Fairview - HealthEast
Mayo Clinic
Midwest Radiology
North Memorial
Rayus - formerly CDI
Summit Orthopedics
Twin Cities Orthopedics
Other
Note: It normally takes 2 days to get the images and report.
Are you an athlete on a sports team?
*
Yes
No
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Next
I understand that the date/time requested above is not guaranteed, and I will wait to hear from Summit Orthopedics for appointment confirmation.
*
Please Select
I understand
Appointment
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Next
Patient Details
Please enter all information as stated on your license/insurance card
Full Name
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Physical Sex
*
Please Select
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
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Next
Submit Your Request
After you submit your request, a Summit Orthopedics appointment scheduler will reach out to you for confirmation within 1-2 business days. Thank you for trusting your care with Summit Orthopedics.
Submit
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