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.

Allergies

Patient Instructions for Checking Out Allergy Extracts

Clinician's Instructions for Sending Allergy Extracts to UHC

Instructions for Prescribing Allergists

Oregon Contraceptive Care (CCare)

CCare Enrollment Form

Immunization Form

UO Certificate of Immunization Status

Dental Clinic Forms

UHC Dental Clinic Patient Registration Form

Consent to Bill Dental Insurance

Dental History Form

Medical History Form

Medical Records

Translated forms are provided for reference only. The English language versions must be used when submitting forms to the health center.

Release of Information

• Release of Information–Arabic
• Release of Information–Chinese
• Release of Information–Japanese
• Release of Information–Korean

Notice of Privacy Practices (NPP)

• Notice of Privacy Practices–Arabic
• Notice of Privacy Practices–Chinese
• Notice of Privacy Practices–Japanese
• Notice of Privacy Practices–Korean

Consent to Treat

• Consent to Treat–Arabic
• Consent to Treat–Chinese
• Consent to Treat–Japanese
• Consent to Treat–Korean

International Student Insurance Compliance Form

• Insurance Compliance Form–Arabic
• Insurance Compliance Form–Chinese
• Insurance Compliance Form–Japanese
• Insurance Compliance Form–Korean

Travel Clinic Forms

Pre-Travel Worksheet

Student Travel Guidelines

Forms for Students Under 18 Years Old

Billing Consent Form

Request for Waiver

UO Health Plan Enrollment—Domestic students

UO Health Plan Enrollment—International students

Translations of Common Medical Terms

Arabic

Chinese