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Medical and Vision Forms

If your provider has indicated that you need to complete forms found online, please print and fill out the necessary forms below.

Consent to Bill and Treat

HIPAA Notice of Privacy

Southside Registration

Sliding Fee Scale Application

Si su provedor de salud le ha indicado que usted complete formularios en linea, por favor sirvase a llenar estos formularios en los enlaces de abajo.

Consentimiento Para Tratamiento

Notificación de Confidencialidad

Formulario de Registro

Aplicación Para Programa de Descuento

Formularios Médicos y de Visión

Contact Information

Medical (612) 827-7181

Dental (612) 822-9030

Vision (612) 821-2003

Behavioral Health (612) 827-7181

Fax Medical and BH (612) 767-4545

Fax Dental and Vision (612) 821-2818

Locations

Southside Medical & Behavioral Health

324 East 35th Street

Minneapolis, MN 55408

Dental & Vision

4243 4th Ave South

Minneapolis, MN 55409

Política de Privacidad

Southside is an FTCA Deemed Facility

This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

All patients have the right to receive considerate, respectful delivery of care regardless of age, race, color, national origin, culture, ethnicity, language, socioeconomic status, religion, physical or mental disability, sex, sexual orientation, gender identity or expression, insurance status, or ability to pay for services.

No one is ever turned away for the inability to pay. Southside Community Health Services (Southside) is a 501c (3) nonprofit, federally qualified health center (FQHC) providing access to primary care to anyone in need in South Minneapolis and the surrounding areas.

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