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Client Registration Packet – English

CCare Enrollment (Family Planning Services only)

Supporting Documents

PDF icon Acknowledge and Consent (HIPAA) (252 KB)
PDF icon Adult Medical and Social History (216 KB)
PDF icon Consent and Acceptance of Clinic Policies (128 KB)
PDF icon Employment Information (212 KB)
PDF icon Full Registration Form (240 KB)
PDF icon Income Verification for Sliding Fee Discount (59 KB)
PDF icon No Show Policy Acknowledgment (457 KB)
PDF icon Pediatric Medical History (for children medical appointments only) (110 KB)
Health Department
  • Overview
  • HIPAA
  • Advisory Committees
  • Alerts and Notifications
  • Behavioral Health
    • Crisis Services
      • Benton County Crisis Center
    • Adult Behavioral Health
    • Adult Substance Use Disorder Treatment
    • Children and Family Program
  • Developmental Diversity (Disabilities)
    • Programa de Diversidades de Desarollo
    • Resources
    • Videos
  • Environmental Health
    • Advisory Committees
      • Food Service Committee
    • Animal Bites
      • Bats And Rabies
    • Domestic Well Safety Program
    • Drinking Water
    • Food Establishment Licenses
    • Food Handler Training
      • Food Safety Focus Newsletter
    • Healthy Homes
    • Septic System/ Onsite Waste Water
  • Forms
    • Brochures – English
    • Brochures – Spanish
    • Client Registration Packet – English
    • Client Registration Packet – Spanish
  • Health Management Services
    • Billing
    • Vital Records
  • Housing and Homelessness
    • HOPE Recommendations & Progress
      • HOPE News
      • HOPE Stories
    • HOPE Community Engagement
    • HOPE Meetings
    • Cold Weather Resources
    • Hot Weather Resources
  • Immunization Program
  • Oregon Medical Database
  • Pay My Bill
    • Point and Pay
  • Public Health
    • Communicable Diseases
      • Mpox (Monkeypox)
    • Disease Reporting
    • Family Planning
    • Harm Reduction Program
    • Health Promotion
    • Health Status Report
      • Demographics
      • Socioeconomic Health
    • Maternal & Child Health
      • Babies First
      • CaCoon Program
      • Family Connects
      • Maternity Case Management
    • Preparedness Program
    • Tobacco Prevention
      • Ready to Quit Tobacco?
    • Tobacco Retail License Program
    • WIC Program
    • Youth Coalition

Contact Information

Mailing Address
Benton County Health Department
PO Box 579
Corvallis, OR 97339

Office Location
Benton County Health Department
530 NW 27th Street
Corvallis, OR 97330

Phone: 541-766-6835

Office Hours
Monday - Friday
8:00 a.m. - 12:00 p.m
1:00 p.m. - 5:00 p.m. 

Closed on holidays

If this is a medical emergency, please call 911.

View Full Contact Details

Upcoming Events

  • Mental Health Addictions and Developmental Disabilities Advisory Committee (MHADDAC) Meeting
    02/07/2023 - 3:00pm
  • HOPE Executive Committee Meeting
    02/08/2023 - 4:00pm
  • HOPE Advisory Board
    02/22/2023 - 4:00pm

View the Health Department Calendar

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