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Patient Forms

Primary Care Forms

If you need assistance or would like us to mail you the forms, please call our office at (541) 492-4550.

Adult Forms

Pediatric Forms

Adult Psychiatric Medical Forms

Pediatric Psychiatric Medical Forms

Mental Health Forms

If you need assistance or would like us to mail you the forms, please call the office nearest you: Douglas County (541) 440-3532, Coos County (541) 751-0357, Curry County (877) 408-8941

Douglas County

Coos County

Curry County

Assertive Community Treatment

Substance Use Treatment Forms

If you need assistance or would like us to mail you the forms, please call the office nearest you: Douglas County (541) 492-0152, Coos County (541) 751-0357, Josephine County (541) 474-1033, Curry County (877) 408-8941

Douglas County

Coos County

Josephine County

Curry County

Other Forms & Information

Financial Discount Application
English | Español

Audio Video Recording Consent
English | Español

Notice of Privacy Practices
English | Español

Voter Registration
English | Español

Media Release Form
English


This health center receives U.S. Department of Health and Human Services (HSS) funding and has U.S. Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.