Health Clinic Forms

Forms for New Patients

All new patients need to complete the new patient paperwork before they can be seen by a provider through telehealth, a phone visit, or in-person in the clinic.

  1. New Patient Paperwork
  2. Medical History Form
  3. Please read Notice of Privacy Practices

If you have been seen by another provider and wish to follow up care at the health clinic please complete a release of records form prior to your appointment so we can give you the best care possible.

Please bring you medications with you to your appointment, or take photos of them with your phone. It is important that we have the name, dose and frequency of all medications that you take.

Forms for Telehealth

All patients being seen for telehealth need to be within the state of Oregon at the time of the appointment, and need to complete the telehealth consent form prior to the appointment. This form needs to be completed once.

Sports and Program Physicals

Please email your completed physical form to prior to your telehealth visit.

Oregon Health Plan Sign up Assistance

We are happy to help you sign up for the Oregon Health Plan (OHP). Call us to make an appointment to sign up for OHP Please fill out he Community Partner Assistance Consent and email the form to prior to your appointment. 

Contact the Health Clinic

health clinic location in building 18

The Health Clinic is located on Lane's Main campus, Building 18, Room 101.

Lane Community College
Health Clinic
4000 East 30th Ave.
Eugene, OR 97405

Building 18, Room 101
Monday-Wednesday 8:30-4:30
Thursday 10-4:30
Fridays 8:30-2 (no appointments available on Fridays)
LCC is closed on Fridays during the summer.

If you have an emergency when the clinic is closed, call Campus Public Safety (541) 463-5555 or dial 911.
If you are having a mental health emergency call or text 988

The LCC Health Clinic does not provide after-hours medical care. If you need a prescription refill, contact your pharmacy.