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Enrollment Form Pages 1,2, & 3 are required. You may fill out pages one or two in English or in Spanish. Page three is available only in English:
You will be eligible for this program if:
- You have coverage on the Oregon Health Plan
- You have insurance that covers contraceptive management
- You were sterilized more than 6 months ago
- You cannot show proof of citizenship or identity
Eligibility, once determined, will remain effective for one year (12 months) from date of initial determination. Eligibility determined at one site is accepted at all FPEP sites in Oregon.
Eligibility screening for the FPEP program must be done prior to making an appointment or using the Pharmacy. You must complete and sign the FPEP Enrollment Form and provide appropriate documents to the University Health Center Reception Desk anytime during operating hours. Eligibility will be verified and you will be notified within a few days of this determination. If you met FPEP eligibility, you will be instructed to pick up your FPEP enrollment card at the University Health Center Reception Desk. You can then make an FPEP appointment to be seen. Eligibility is valid for one (1) year.
© 2000-2007 University of Oregon Health Center, Eugene, OR 97403-1232 (541) 346-2770
Latest Revision - 12/4/2007