Triple P Interest Form If you live in Lane County and have a child aged 2-12, you can get Triple P Online for free by filling out the form below. If you are human, leave this field blank.First Name *Last Name *Email *Zip Code *Phone *Preferred way to be contacted *PhoneEmailTextPlease list the ages of your children *Are you or your child on the Oregon Health Plan (OHP)? *YesNoWho is your (or your child's) OHP provider? *Trillium Community Health PlanPacificSource Health PlansI don't knowChild is not on OHPHow did you find out about the Triple P program? *A Triple P Provider (through discussion group or individual consultation)Doctor/PediatricianCounselor/TherapistA friend or relativeAn agency (ex: Parenting Now or ODHS)FacebookGoogle/the InternetPosterOregon Family MagazineSiuslaw News (print)Siuslaw News (website)LTD bus adEugene WeeklyLane Kids NewsletterEugene/Springfield BillboardFlorence BillboardreCAPTCHA is required.Please note that this form is for Triple P applicants who reside in Lane County, Oregon only. Submit
