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

Eagle Point School District 9