The Minnesota State Refugee Health Program will assist newcomers to navigate health resources and coordinate the domestic medical screening. The program is requesting the new arrivals information to help coordinate health services.


Please fill out only one form per family.


This is a secure form and only authorized public health staff have access to the information. The Minnesota Department of Health follows the data storage and handling requirements under the Minnesota Government Data Practices Act.


You will receive a call from Local Public Health to discuss the health screening. This process may take up to two weeks. If you don't receive a call from Local Public Health within two weeks of submitting this survey, please contact

Thank you!

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