Forms
Income Worksheet – Please print, fill out, and bring with you to your appointment.
Income Worksheet – Please fill out via our patient portal, found under the “Health Forms.”
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 via our patient portal, found under the “Health Forms.”
Release of Records – Please print, fill out, and mail or fax to MyAlly Health.
Release of Records – Records can also be accessed via our patient portal. This request can be found under ‘Health Record’ on the patient portal.
Resources
Community Violence Intervention Center (CVIC)
Centers for Disease Control and Prevention
Grand Forks County Social Services
North Dakota Cancer Coalition (NDCC)
Interpreter Services – Available at no cost to the patient in their language of origin