Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Administrative Services

  1. Data Request Form - Members of the Public

    Members of the Public should utilize this form to request data

County Board

  1. Itasca County Committee/Commission/Board Application

    This form is used to apply for positions on Itasca County Committees/Commissions/Boards.

Health & Human Services

  1. Adult Health Intake

    Public health intake form.

  2. Health Care Transportation Reimbursement Form

    Medical provider only completes this reimbursement form.

  3. Online: Children's mental health Respite Grant Application

    Online application for case managers to request respite

  4. Online: Child Protection Suspected Child Abuse/ Neglect Reporting Form

    Online form for reporting suspected child abuse/ neglect form

  1. Application for Appointment

    Please fill out an application for an appointment with the Itasca County Health and Human Services Advisory Committee.

  2. Medicare Redetermination Request Form
  3. Online: Adult Mental Health Case Management Referral Form

    Online form to submit referrals for adult mental health case management services.

  4. Online: Children's Mental Health Case Managment Referral Form

    Online form to submit referrals for children's mental health case management services.


  1. Health Appraisal Form

    Wellness and Prevention Individual Health Appraisal Survey

Itasca County

  1. Affidavit of Restitution

    Access the request for restitution and affidavit form.

  1. Itasca County Rule 79 Adult Mental Health Referral

    Access the Adult Mental Health Referral form.