Health Clinic Forms

Release of Records

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.

Release of Records Form

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.

Sports and Program Physicals

Please bring this with you to your Health Clinic office visit. 

Sports Physical Form

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 the Community Partner Assistance Consent and email the form to lcchealthclinic@lanecc.edu prior to your appointment. 

Community Partner Assistance Consent Form