Fillable Online MnCHOICES Referral Form - Anoka County 2026

1. Click ‘Get Form’ to open the Fillable Online MnCHOICES Referral Form in our editor.
2. Begin by entering the date at the top of the form. Next, fill in your referral source name and phone number, along with your relationship to the individual being referred.
3. In the 'Client Information' section, provide details such as the client's name, date of birth, social security number, marital status, and contact information including address and email.
4. Indicate if an interpreter is needed and specify the language spoken. Mark whether the client is certified disabled and list any programs of interest.
5. Complete sections regarding current living situation, legal authority for decision-making support, insurance status, and financial information as applicable.
6. Fill out provider information including primary physician and mental health provider details. Lastly, detail any assistance needed in various areas such as mobility or personal care.
7. Review all entries for accuracy before saving your completed form. Once finished, send it as an attachment to Long Term Services and Supports Intake via email or fax.

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