Knute Nelson Referral Form

This form is to be used when making a referral to any team within the Knute Nelson Continuum. The referral will be delivered to the appropriate team based on the selections within the form. Please note, going forward ALL referrals should be sent this way to ensure the receiving team has the appropriate information, and can follow up promptly. This should replace any current process that is being used.

If you have any questions about the form or process, please contact Jenny Staples at 320.759.3400 or ext. 12213.

Referral By

Patient Information


Attachments

Primary Care Physician

Alternate Contact