To make your genetics appointment, you will be directed to Mary Riske, Nurse Geneticist when you call (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 parent's names and/or adoptive parent's name
• 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 physcian 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 partner's 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 clicking on them. Please return them as quickly as possible to our office.

Word Document	PDF Document	Spanish Document (Word)
Release of Information Form	Release of Information Form	Solicite Para la Liberación de Información
Billing Form	Billing Form	Forma de facturación
Family History Form	Family History Form	HISTORIA de FAMILIA
Prenatal Development of Patient who is a child	Prenatal Development of Patient who is a child
Birth History of Patient Seen	Birth History of Patient Seen
Other Forms For Families With Children Who Have Special Needs
North Dakota's Children with Disabilities Coverage program North Dakota for families to access the Medicaid program as a critical supplemental insurance	ND Dept of Human Services Application for Health Care Coverage for Children, Families & Pregnant Women
	Medicaid coverage along with economic assistance programs Application for Assistance (SFN 405)
	Children with Medically Fragile Needs Application

To obtain our recent brochure, describing North Dakota's Genetic/Birth Defects Evaluation and Counseling Service, click here.