Certain orders may require you to provide certain information via one or more form(s) below. Please read the descriptions below to determine the form(s) you require, then click to download the document.
IMPORTANT: Once you have filled out your information,
you may return forms to us either by postal mail or via fax. Due to HIPAA regulations protecting your privacy, we can not accept the forms electronically or via email.
6024 Blue Circle Drive
Minnetonka, Minnesota, 55343
The Assignment of Benefits form indicates that you have insurance and that your insurance company should pay Anodyne Inc. directly for the products that we provide to you. This form also authorizes the release of health information from your insurance company and doctors offices to Anodyne Inc. Please review the form in its' entirety, fill out and return as required. Instructions for returning the form are included above.
This form allows you to request services from Anodyne. Please provide as much information as you have so we can complete the order as soon as possible. Providing your contact information allows us to reach out if necessary. We may also check with the nurse or physician for additional documentation and guidance. If a physician’s prescription is available, you may include that as well. Instructions for returning the form are included above.