Get Duplicate Card Request - Public Health Oregon

Filling out the Duplicate Card Request form for the Public Health Oregon is essential for ensuring you receive a replacement card efficiently. This guide provides clear instructions to help you navigate the online process with confidence.

Follow the steps to complete your Duplicate Card Request online.

1. Click ‘Get Form’ button to obtain and open the Duplicate Card Request form online.
2. Fill out the patient legal name section by entering your last name, first name, and middle initial. Ensure that the information is accurate to avoid delays in processing.
3. Provide your date of birth in the designated field. This information is necessary for verifying your identity.
4. Enter your mailing address in the required section. Make sure to include all relevant details to ensure proper delivery of your replacement card.
5. Fill in your phone number in the appropriate field. This allows the office to contact you if there are any issues with your request.
6. In the reason for duplicate card request section, clearly state why you need a duplicate card. This field is essential for processing your request.
7. Sign and date the form in the patient signature section. Your signature certifies that the information provided is true and accurate.
8. After completing the form, save your changes. You have the option to download, print, or share the form for your records.

Complete your Duplicate Card Request online today to ensure a smooth and efficient replacement process.