Download and complete the following forms for applicable services. Submit completed forms at the main reception desk or the drop-box outside of our 13th Street entrance.
Oregon Contraceptive Care (CCare)
Dental Clinic Forms
Translated forms are provided for reference only. The English language versions must be used when submitting forms to the health center.
- Release of Information–Arabic
- Release of Information–Chinese
- Release of Information–Japanese
- Release of Information–Korean
- Notice of Privacy Practices–Arabic
- Notice of Privacy Practices–Chinese
- Notice of Privacy Practices–Japanese
- Notice of Privacy Practices–Korean
- Insurance Compliance Form–Arabic
- Insurance Compliance Form–Chinese
- Insurance Compliance Form–Japanese
- Insurance Compliance Form–Korean