The State of Oregon and Oregon State University require the submission of a completed health history form and proof of 2 doses of MMR (measles, mumps, rubella). The preferred method for submitting the information is via the Patient Portal. If you are unable to use the Patient Portal you may print the form from the following link and fax it to Student Health Services at 541-737-9665.
You may receive a hard copy of your record at a cost per page or may have a copy forwarded without cost to your personal health care provider by completing the Authorization to Release Medical Information Form.
If you need a copy of your itemized billing statement, please complete this form and place it in any of the “Request for Itemized Billing” boxes conveniently located on the 2nd floor of the Student Health Center. Your billing statement will be mailed to you. This statement contains all the coding that is needed for your insurance company to process your claim. This bill will not reflect charges from the SHS Pharmacy (please request those statements directly from the Pharmacy).
All of the above forms require Adobe Acrobat Reader to view. If you haven't yet installed the program on your computer, you can download the application for free. Simply click on the icon below and follow the directions given.
