Forms

Release of Information Authorization Form

ROI Form

Medical History Form

Pediatric Adult Male Adult Female

Other Forms

Patient Comment Form Sliding Fee Application

Medical Telehealth Consent Form

Bring to Your Visit

Photo I.D.
Insurance Card
Containers of current medications, vitamins & supplements
Sliding fee scale applicants – proof of income
Release of Information (ROI) form

Download ROI Form

What's New

Upcoming Vaccine Events

Duluth Behavioral Health has openings!

All Updates

This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

Land Acknowledgment Statement

We acknowledge that our clinics are located on traditional, ancestral, and contemporary lands of Indigenous people who cared for and called these lands home for generations. Our clinics reside on Ojibwe and Dakota lands, and we recognize that the spirit of the Ojibwe and Dakota permeates these lands. The land we reside on has great spiritual and historical significance for Indigenous peoples past and present. We strive to build tribal relations and support tribal sovereignty in our community.

Lake Superior Community Health Clinic complies with applicable federal civil rights laws, and does not discriminate on the basis of race, color, national origin, age, disabilities, sex, sexual orientation, or gender identity.

Patient Resources