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Dallas County Health Department

phn@dallascountyiowa.gov

25747 N Avenue Suite C Adel, Iowa 50003

515-993-3750

Section 1 of 4 in this document

Dallas County Health Navigation Referral Tool

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Section 2 of 4 in this document

Today's Date

Date Picker

Client Name

Full Address

Client Phone Contacts

Area of Need

Section 3 of 4 in this document

Has Client Been Made Aware You Are Making This Referral?

Do You Have a Signed Release of Information on File?

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