Mcleod County Jail Work Release Entrance Form Page 3
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5T R E A T M E N T . M E D I C A L . O R C O U R T A P P O I N T M E N T S
Type o f Appointment:
Date:
A M P M
Time:
Location o f Appointment:
Contact Person:
Telephone #:
Is this a scheduled weekly appointment? Y E S N O
A l l information provided is confidential and will be used for M c L e o d County Jail use only.
I hereby certify that the above statements are true to the best o f my knowledge.
Signature:
Date:
Witness:
Date:
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Parent category: Legal