Forms

Instructions for completing forms for clinical and community services:

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Step 1: Fill Out Form Completely

• Ensure that all sections of the form are legible, completed accurately, and all contact information is current. ​

• For pediatric clients, please include a signed release of information if you are not the legal             guardian.

 

Step 2: Submit the Form

After completing the form, choose one of the following submission methods:

• Email Submission:

  • Subject line suggestion: “[Form Type] Submission – [Client’s Name and DOB]”

  • Email form to: Health@redlakenation.org 

• Fax Submission:​

  • Subject line suggestion: “[Form Type] Submission – [Client’s Name and DOB]”

  • Fax form to: (612) 416-2093

• In-person submission:

  • Drop off forms at Mino Bimaadiziwin Wellness Clinic with the Front Desk Coordinator​.

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Step 3: Follow-Up

• After submitting a referral, you will be contacted by the Care Coordinator within 5 business days.

• If you have any questions about a referral you have made or forms you have submitted please contact the Front Desk Coordinator at (612) 767-7892 or email Health@redlakenation.org.

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