Forms

The following forms can be filled out online by clicking on the name of the form. If you have any questions about what to bring to your appointment or how to fill out any of the forms below, give us a call at (612) 588-9411 and someone will assist you.

Consent for Service form

Release of Information form

Patient Registration form

Sliding Fee Discount Application

Aplicación para Descuento de Tarifa Variable

You can help support front line healthcare workers from home during the COVID-19 outbreak by making masks for Neighborhood HealthSource staff. Please bring mask donations to Central Clinic during open clinic hours. A member of our staff will assist you.

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Mission & Services

Neighborhood HealthSource provides a full range of primary medical and behavioral healthcare services at four clinics in Minneapolis and the north metro. We work hard to make sure everyone in our communities can access the care they need.

We are committed to treating all patients, with and without health insurance, and believe that cost should never be a barrier to care.

Payment Options

Providing care that our patients can afford is vital to our mission. We have an income-based sliding fee program for patients with and without insurance.

Call: 612.588.9411

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Copyright © 2018 - 2020 Neighborhood HealthSource

Neighborhood HealthSource has medical malpractice insurance coverage through the Federal Tort Claims Act (FTCA).

Neighborhood HealthSource

Neighborhood HealthSource