This online form will take you about 10 minutes to complete and will expedite your check-in process. If you prefer to complete the forms in our office, please arrive 10-15 minutes early for your appointment.
All questions marked with an * are required.
CONFIDENTIALITY, DISCLAIMER AND LIMITATIONS OF SERVICE
Pregnancy Resource Centers of Central Oregon (PRCCO) is a Christian non-profit organization offering pregnancy test services, limited OB ultrasound exams (up to 20 weeks) and other services. All of our services, information and resources are free.
Confidentiality: All information is kept confidential with a few exceptions. Oregon law and/or our concern for your safety requires that we report knowledge of a Client who is a danger to themselves or others, is abusing a minor or is a minor being abused, is a victim of rape, or a runaway.
Consultations: Our Client Advocates are trained volunteers and are not licensed or degreed personnel. Any consultation you receive is not intended as a substitute for professional counseling.
Pregnancy Testing: Your pregnancy test is 97-99% accurate; however you should seek to confirm the results of your test with a licensed physician. This applies to both nurse and self-administered tests. Whether the test is positive or negative, you should consult with a licensed physician. We do not provide prenatal care.
Ultrasound: The limited OB ultrasound is a medical service and is provided by a licensed Registered Nurse (RN) or Registered Diagnostic Medical Sonographer (RDMS) under the oversight of a local licensed Medical Director.
Abortion: This Center does not offer or refer for pregnancy termination services.
Adoption: We are not a licensed adoption agency and we are not affiliated with any adoption agencies. We offer information about adoption and can provide a list of several adoption agencies for review. Our endorsement of any adoption agency does not warranty their services nor do we receive any financial remuneration from any agency. We do not represent prospective adoptive parents nor assist them in their search for a child. If you decide to consult with an adoption agency, that agency is independent of PRCCO.
Referrals: Although we give referrals for medical care, professional counseling, housing, and other community services, we assume no legal responsibility for services provided by other agencies or individuals; nor are the views of these organizations or individuals necessarily the views of PRCCO.
Fees: All of our services are free of charge. We do not accept any form of payment or collect any insurance information.
Recording Devices: We do not give permission for our staff to be recorded and ask that no recording devices be used while inside this Center. We ask that you turn off your cell phone and all recording devices while inside this Center.
By signing this form (electronically) I am agreeing to hold Pregnancy Resource Centers of Central Oregon harmless from and against all claims or causes of action arising out of a referral by Pregnancy Resource Centers of Central Oregon. I have read and understand the above and hereby authorize the staff of this Center to discuss and render available services as necessary for my care.