Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Health & Human Services

  1. Adult Health Intake

    Public health intake form.

  2. Health Care Transportation Reimbursement Form

    Medical provider only completes this reimbursement form.

  3. Online: Adult Mental Health Case Managment Referral Form

    Online form to submit referrals for adult mental health case management services.

  4. Online: Children's Mental Health Case Managment Referral Form

    Online form to submit referrals for children's mental health case management services.

  1. Application for Appointment

    Please fill out an application for an appointment with the Itasca County Health and Human Services Advisory Committee.

  2. Medicare Redetermination Request Form
  3. Online: Child Protection Suspected Child Abuse/ Neglect Reporting Form

    Online form for reporting suspected child abuse/ neglect form