The North Dakota Office of Refugee Services will assist newcomers to navigate health resources and coordinate refugee 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. 

You will receive a call from the resettlement agency to discuss refugee medical screening. This process may take up to ten days. If you do not receive a call from the resettlement agency within ten days, please contact refugeeservices@nd.gov

The information collected in this survey is very important in ensuring that the new arrival(s) receive appropriate services. Please fill it out as completely as you can.

Thank you! 

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* 1. Full Name

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* 2. What is your phone number?

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* 3. Which of the following best describes you?

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