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Registration Forms

Download, print, and fill out the forms that you will need for your appointment.

  • ALL patients need to fill out forms 1, 2, and 3.
  • Fill out additional forms as instructed by Public Health Nursing Staff.
  • Call for an appointment. (Find a Public Health Center)

PLEASE DO NOT EMAIL the forms; they contain your Protected Health Information.

  1. Client Registration Form
  2. DHSS Acknowledgement of Privacy Notice (06-5876) 09-03
  3. DHSS Notice of Privacy Practices
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