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218-305-4860

crisis@rurallivingmn.com
Ely Crisis HouseEly Crisis House
Providing Crisis and Respite services
to both adolescents and adults
  • Home
  • Intake
  • About
  • Ely Business Directory
  • Contact Us

Intake

Home Intake

Please complete this form prior to intake.

Intake Check List

Items needed at the time of arrival:

  • Medical/Insurance Card-Medical history if possible to assist
  • Medication/Prescription- List
  • Social Security Card or Number
  • Minnesota Identification Card, Minnesota Driver’s License
  • Birth Certificate
  • Minimal personal belongings
  • Please provide as much background information as possible.

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