White Bird Clinic
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Medical Forms

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Download PDFs

  • Consent and Hippa Form (full) (107 KB)
  • Demographics Questions (49 KB)
  • Family Release of Information (68 KB)
  • HIPAA English (51 KB)
  • New Patient Triage Screening Form (135 KB)
  • Patient Rights and Responsibilities (42 KB)
  • Release of Information (ROI) (23 KB)
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General Inquiry Contact Form

Recent Updates

White Bird Clinic Receives Federal Funding for Mental Health Center Expansion Dec 22nd, 2022
White Bird Clinic Launches Stay Warm Drive Nov 15th, 2022
Cold Weather Donation Drive Nov 5th, 2021
White Bird Executive Coordinator Attends White House 4th of July Celebrating Nation’s Birth and Pandemic Progress Jul 6th, 2021
CAHOOTS Initial Consultation Survey Jun 29th, 2021
White Bird Receives American Rescue Plan funding Apr 22nd, 2021
Drag Queens and Vaccines! Apr 19th, 2021
Hearts for Hospice logo
White Bird End of Life Counseling Apr 12th, 2021
Temporary Relocation of White Bird Medical Clinic Apr 9th, 2021
Second Gentleman Doug Emhoff Visits White Bird Clinic's Vaccine Site Apr 5th, 2021
White Bird Clinic Supports the Right to Rest Act Mar 31st, 2021
White Bird Clinic is one of Nine Oregon Health Centers to Join Federal Vaccine Program Mar 12th, 2021
White Bird Partners with the WOW Hall for COVID-19 Vaccination Program Mar 8th, 2021
White Bird is Vaccinating the Community Mar 8th, 2021
Crisis 101 Mar 2nd, 2021

COVID-19 Update from Lane County

HIGH ALERT: Increased cases reported. Take measures to limit most contact and modify everyday activities to reduce personal exposure.

Go to County Web Site (new window)

Medical is Accepting New Patients

We take OHP!

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Looking for CAHOOTS?

To access CAHOOTS services for mobile crisis intervention, call police non-emergency numbers 541-726-3714 (Springfield) and 541-682-5111 (Eugene).

To access our 24/7 Crisis Services Line, call 541-687-4000 or toll-free 1-800-422-7558.

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