Online Forms

Northwest EyeCare Professionals offers our patient form(s) online so they can be completed in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) or bring it with you to your appointment. If  you would like to fax this information, please send to either of the following offices: Clackamas (503) 657-7066 or Vancouver (360) 574-5576.
  

This lets us know the history and current state of your health. Some forms are required for our patient file. What questions, concerns, goals, regarding your vision can we help you with? Let us know!

Please down load and complete the following:

Welcome Form-Required for New Patients

Download & Print Form

Patient Questionnaire-Required for New Patients or patients not seen over 3 years

Download & Print Form

HIPAA Forms-Required for New Patients

Download & Print Form

Privacy Policy-Required for New Patients

Download & Print Form

Office Policy-Required for New Patients

Download & Print Form

Medical Records Release Form-Only if you would like records transferred TO our office from another provider for your appointment

Download & Print Form

Medical Records Release Form-Only if you would like records transferred FROM our office to another provider

Download & Print Form

TBI Questionnaire-Only for patients with balance issues/brain injuries/Neurological disease

Download & Print Form

Non Covered Services Form- ONLY complete when requested by office staff

Vision Therapy Forms (These are for information only. These are given when therapy is prescribed.)

Visual Sensorimotor Testing - Developmental

Download & Print Form

Visual Sensorimotor Testing - Rehabilitative

Download & Print Form

VIP Member Registration Form - Optional

This form can be filled out to register for access to the members only section of our website. You can also sign up for our monthly newsletter to keep up on current vision issues, as well as receive special promotions and invitations to VIP events in our office. Print out this form and bring it with you to our office.  If you prefer, Click Here and register online instead!  The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form