Forms
Income Worksheet – Please print, fill out and bring with you to your appointment
Income Worksheet – Please fill out and submit online.
Request to Receive Family Planning Screening Services – Please print, fill out and bring with you to your appointment
Request to Receive Family Planning Screening Services – Please fill out and submit online.
Release of Records – Please print, fill out and mail or fax to MyAlly Health
Resources
Community Violence Intervention Center (CVIC)
Centers for Disease Control and Prevention
ND Department of Health Tobacco Cessation
Grand Forks County Social Services
North Dakota Cancer Coalition (NDCC)
Interpreter Services – Available at no cost to the patient in their language of origin