Skip to main content
Oregon.gov Homepage

Death with Dignity Forms

Patient form

Provider forms

OHA form (internal use only)

The envelope used to return all forms should be marked as CONFIDENTIAL and mailed to:

Oregon Health Authority
Center for Health Statistics
PO Box 14050
Portland OR 97293-0050
Attn: Craig New

Contact Us

Center for Health Statistics staff can answer inquiries about Oregon's Death with Dignity Act.

Email: dwda.info@state.or.us

Fax: 971-673-1201


How to order hard copies of the Death with Dignity forms

You may order hard copies of the rules and reporting forms by emailing dwda.info@state.or.us or contacting us at:

Oregon Health Authority
Center for Health Statistics
PO Box 14050
Portland OR 97293-0050
Attn: Craig New
Phone (971) 673-1150

Your browser is out-of-date! It has known security flaws and may not display all features of this and other websites. Learn how

×