Signed in as:
filler@godaddy.com
Signed in as:
filler@godaddy.com
These are fillable forms, please complete the forms, save as a PDF and send them to assuredclinic@gmail.com
7701 MDH EMAIL (pdf)
Download7702 MC FORM 1-3 (pdf)
Download7703 COVID-19 FORM (pdf)
Download7704 SURVEY FORM (pdf)
Download7705 PRIMARY CARE CONSENT (pdf)
Download7706 CLINIC REGISTRATION FORM (pdf)
Download7707 SUBOXONE AGREEMENT (pdf)
Download7708 MC RE-CERT FORM 1 (pdf)
Download7709 PEG SCORE 2023 (pdf)
Download7710 COVID-19 Registration (pdf)
Download7711 MC RECOMMENDATION LETTER (pdf)
Download8804 MODERNA EUA FACT SHEET (pdf)
Download8805 COVID-19 PRE-VACCINE SCREENING (14) (docx)
Download8806 EUA PFIZER 12 YEARS AND OLDER (pdf)
DownloadASSURED HEALTH
8421 W. BROADWAY AVE, BROOKLYN PARK, MN 55445 & 3333 W. DIVISION ST, ST. CLOUD, MN, 56301
Copyright © 2022 ASSURED HEALTH - All Rights Reserved.
This website uses cookies. By continuing to use this site, you accept our use of cookies.