Download Forms & Other Important Information
Welcome to La Pine Community Health Center
Thank you for choosing us to be your health care provider. LCHC is a primary care health center
Please review our patient forms for more information and to download forms you’ll bring with you to your appointments.
Download Forms
New Patient Packet (Adult)
Complete the attached packet for adult patient care.
New Patient Packet (Pediatric)
Complete the attached packet for pediatric patient care.
Discounted Fee Application
Complete the attached form to request discounted fees.
Notice of Privacy Practices
Please review the attached Privacy Practices.
Disclosure of Protected Health Information (Adult)
Complete the attached form for protection of your health information.Disclosure of Protected Health Information (Pediatric)
Complete the attached form for protection of your child's health information.Medical Release Form
Complete the attached form to request or send records to or from LCHC.MyChart Proxy Access Agreement - Adult
Complete the attached form to enable proxy access.MyChart Proxy Access Agreement - Teen
Complete the attached form to enable proxy access.MyChart Proxy Access Agreement - Child
Complete the attached form to enable proxy access.Need An Appointment?
We are here to serve you! Call (541) 536-3435 to make an appointment or ask any questions.
Walk-In Clinic
Need medical care for a minor illness or injury but can’t wait for an appointment? Visit our
Walk-In Clinic in La Pine.
After Hours Phone Number (541) 536-3435
Some examples of common walk-in conditions: sore throat, ear infection, minor cuts or burns, muscle strains and cold or flu symptoms.