Minor consent and clinic registration form

Students must complete this form to receive services at a Minneapolis School Based Clinic.

Before you begin

We will ask you if you have health insurance. If you do, we'll ask you to tell us the:

  • Type of insurance
  • Insurance policy number
  • Group policy number
  • Policy holder name, date of birth, and social security number

If you do not have or do not know if you have insurance, tell us.

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Contact us

Minneapolis School Based Clinics

Minneapolis Health Department







Public Service Building
505 Fourth Ave. S., Room 520
Minneapolis, MN 55415