Mpls-School-based-clinics

Minneapolis School Based Clinics on Facebook Minneapolis School Based Clinics on Twitter Minneapolis School Based Clinics on YouTube
SBC on social media

Forms & Information

What to do before your appointment

Don't waste time filling out forms when you get to the clinic - print them off and fill them out now! Many of the forms only need to be completed prior to your first clinic visit of the school year.

All forms are in PDF format

Clinic Registration & Consent Form

Make sure your parent(s)/guardian(s) have filled this out before you come to the clinic.
This needs to be completed just once during your high school career or if your insurance status changes.

Data Privacy Acknowledgment

Sign once per school year

Personal Health History

Complete once per school year

Other Forms

Vaccine Administration Consent
Make sure your parent(s)/guardian(s) have filled this out before you come to the clinic so you can get your shots.

2018-2019 Sports Physical Forms
Minnesota State High School League required sports physical forms.
Sports Physicals are offered during the summer months by appointment and during the school year. MPS requires a sports physical every 3 years for students participating in school sports. Call your School Based Clinic to make an appointment

Sports Physical Welcome Letter

Youth Sports Physical Information Flyer

Consent to Release Medical Information 

Information

Notice of Privacy Practices: Updated 09/18
This notice describes how medical information about students may be used and disclosed and how access to this information can be obtained.

School Based Clinic Brochure
Information on what the School Based Clinics have to offer.

Policies

Minneapolis School Based Clinics is a program of the Minneapolis Health Department.

Accommodations

 Minneapolis Health Department Logo

Should you require a reasonable accommodation in order to fully participate, or information in an alternative format, please contact 612-673-2301.

Para asistencia 612-673-2700 - Rau kev pab 612-673-2800 - Hadii aad Caawimaad u baahantahay 612-673-3500.

Last updated Oct 30, 2018

QUICK LINKS

Home

Contact us

Email updates

Find a service

About this site

For employees

Accessibility:
For reasonable accommodations or alternative formats, contact 311.
People who are deaf or hard of hearing can use a relay service to call 311 at 612-673-3000.
TTY users can call 612-673-2157 or 612-673-2626.

Para asistencia 612-673-2700, Yog xav tau kev pab, hu 612-637-2800, Hadii aad Caawimaad u baahantahay 612-673-3500. 

CONNECT

311 call center

311 TTY relay service

City of Minneapolis Facebook City of Minneapolis Twitter City of Minneapolis YouTube ChaNNEL Minneapolis 311 Minneapolis 14 Government TV City of Minneapolis LinkedIn

Minneapolis, City of Lakes logo