Forms

Forms

The following forms may need to be submitted to us at your visit and are provided here for your convienience.

Accident/Incident Reporting information and form

New Patient Forms

If you are a new patient, please complete ALL the New Patient forms listed below and bring them with you to your first appointment.

As a service to you and to promote better health care, your Provider will encourage you to bring your medications with you in a bag to your appointment. Because adverse drug reactions do occur it is very important that you keep an up to date list of all your medications (prescription and/or over-the-counter medications). Please bring the Medication ID form with you to all your appointments.

  1. Notice of Your Right to Decline Participation in Future Anonymous or Coded Genetic Research
  2. Personal Health History
  3. Privacy Notice
  4. Lane Community College Student Health Clinic Consent to Use or Disclose Clinical Information
  5. Medications ID