Forms

Rogue Community Health offers a school based health center at 3 of our schools Eagle Point High School, Table Rock Elementary or White Mountain Middle School; Anyone is able to visit the health center at any of the locations


Eagle Point High School School-Based Health Center
203 North Platt St, Eagle Point, OR 97524
Phone 541-830-6617

 EPHS Options Letter for Parents Spanish version
 EPHS SBHC Parent Consent for Services Spanish version
 EPHS Consent to Use or Disclose Medical Information - HIPPA Spanish version
 EPHS Opt-Out Forms Spanish version
 EPHS Notice of Privacy Practices Spanish version




Table Rock Elementary School School-Based Health Center
2830 Maple Court, White City, OR 97503
Phone 541-500-0978      Fax 541-830-6353

 TRE Options Letter for Parents Spanish version
 TRE SBHC Parent Consent for Services Spanish version
 TRE Consent to Use or Disclose Medical Information - HIPPA Spanish version
 TRE Opt-Out Forms Spanish version
 TRE Notice of Privacy Practices Spanish version



White Mountain Middle School School-Based Health Center
550 Wilson Way, White City, OR 97503
Phone 541-500-0954      Fax 541-538-2801

 WMMS Options Letter for Parents Spanish version
 WMMS SBHC Parent Consent for Services Spanish version
 WMMS Consent to Use or Disclose Medical Information - HIPPA Spanish version
 WMMS Opt-Out Forms Spanish version
 WMMS Notice of Privacy Practices Spanish version