If you do not have recent medical records with a qualifying condition in hand, you will need to get this signed Release of Information to your healthcare provider.  We need your records as soon as reasonably possible so the doctor is able to review them and have us schedule you if you qualify for an OMMP card.  All the information you need is provided on the form, but feel free to call if there are any questions.

If you are unable to print this document or if you need it mailed or faxed instead, please contact us by clicking HERE or call anytime, 541.981.2620.

Please tell a friend about our clinic and upcoming clinics – and be sure and get yourself scheduled as the first 20 who secure their appointment with medical records will save $25!!