Minneapolis health department

asthma program enrollment

Before we begin, we want to let you know that we are going to ask questions to help prepare our visit with you. The information we'll be asking for is used to figure out what your child’s needs are for asthma equipment that will be brought to you.

• This form will ask you about how well your child’s asthma is under control and if their asthma symptoms have changed recently.
• This form will ask some questions about your home so that we know what free equipment to bring.
• This form will also ask you for your address and contact information. This information is not legally required, but it is necessary for the program to serve you. This information will stay secured in our computer system and only be used in connection with this program by program staff. You may begin filling out the form.

If you are eligible for the program, the response space will show below. If not, please continue to submit the survey, as you may be eligible for other opportunities.

If you are eligible for the program, the response space will show below. If not, please continue to submit the survey, as you may be eligible for other opportunities.

If you are eligible for the program, the response space will show below. If not, please continue to submit the survey, as you may be eligible for other opportunities.

If you are eligible for the program, the response space will show below. If not, please continue to submit the survey, as you may be eligible for other opportunities.

If you are eligible for the program, the response space will show below. If not, please continue to submit the survey, as you may be eligible for other opportunities.

A City of Minneapolis staff member will reach out to schedule an appointment. During the appointment they will bring any asthma related equipment to you.

Please let us know if you have any questions or comments at vu.tran@minneapolismn.gov. Thanks!