Health Center Forms

Forms

• Authorization to Release Information FROM ISHC
  Complete this form to give permission for ISHC to provide information to yourself or others
• Authorization to Release Information TO ISHC
  Complete this form to give permission for someone else to give information to ISHC
• La Grande/Chemeketa Immunization Form
  
• Consent to Treatment
  
• Minor Consent
  
• Medical Exemption Form
  
• Telehealth Consent (Telephone)
  Complete this form to give permission to participate in telephone counseling sessions
• Telehealth Consent (Video Conferencing)
  Complete this form to give permission to participate in counseling via video conferencing (i.e. Zoom)