This page contains information and a form required to register as a Mobile Health Evaluation/Screening Provider in the State of Minnesota. This form is intended for use as reference. It can be downloaded and completed by individuals and organizations seeking to acquire an initial registration.

Please do not use this form to renew a current registration. Currently registered agencies will receive separate notification and instructions for renewal from the Department of Health.

If you are unsure this is the correct registration for your business or have questions, please contact the Licensing and Certification Program at 651-201-4200 or email health.hrd-fedlcr@state.mn.us to obtain additional clarification.

Required Forms and Documents

Please read and understand all applicable documents, statutes and rules list below before registering as a Mobile Health Evaluation/Screening Provider.

Registration Form (PDF)

Related Statutes and Rules

Minnesota Statutes 144.077