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Community Health Service Inc. Logo
  • Services
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    • Behavioral Health
    • Substance Abuse
    • Victim Advocacy Services
  • About Us
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  • Locations
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    • Grafton, ND
    • Moorhead, MN
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  • Services
    • Medical
    • Dental
    • Behavioral Health
    • Substance Abuse
    • Victim Advocacy Services
  • About Us
    • Mission
    • Our Team
    • Board of Directors
    • History
    • Quality
  • Patient Resources
    • Patient Information
    • Forms & Documentation
    • Financial Resources
    • News & Events
    • Helpful Links
  • Locations
    • Crookston, MN
    • Grafton, ND
    • Moorhead, MN
    • Rochester, MN
    • Willmar, MN
    • North Mobile Unit
    • South Mobile Unit
  • Job Opportunities
  • Translate
    • Amharic Arabic Bosnian English French Slovak Somali Spanish

Patient Resources

Forms & Documentation

Forms

Sliding fee application
Demographic form
Personal Representative Request
Telemedicine Informed Consent
Authorization for minors and adults with disabilities

What You Should Know

Privacy Notice
Patient's Bill of Rights
No Show Notice

Formularios (español)

Solicitud de tarifa variable
Forma demográfica
Solicitud de Representante Personal
Consentimiento informado de telemedicina
Autorización para menores y adultos con discapacidad

Lo Que Debes De Saber (español)

Aviso de Privacidad
Derechos del Paciente
Aviso de cancelación

This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

© 2022 Community Health Service Inc.  |  810 4th Ave. S, Suite 101, Moorhead, MN 56560  |  Web Privacy Policy  |  Accessibility  |  Site by The Grenwoods
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