Forms

Patient Registration

New Patient Registration Form
Download and print. Scan and email directly to info@opencitieshealth.org or bring to your first visit.

Financial Assistance

2025 Sliding Fee Scale

Sliding Fee Application

Your Privacy & Rights

Notice of Privacy Practices (English)

Minnesota Patients’ Bill of Rights

Consent Forms

Consent Form to Release Health Information

Telehealth Consent Form

Referral Forms

Open Cities Referral Form

Behavioral Health Forms

Adult Behavioral Health Questionnaire