Northwest EyeCare Professionals offers our patient online forms online so they can be completed in the convenience of your own home or office.
Some forms are required for our patient files. Our office would like to ensure that we have the most up-to-date information possible to deliver the best possible care. These documents lets us know the history and current state of your eye health. What questions, concerns, goals, regarding your vision can we help you with? Let us know!
If this will be your first time visiting NW Eye Care Professionals, please down load and complete the following forms before the scheduled appointment:
Examination and Fees (Required for All Patients) - Download & Print
Welcome Form (Required for New Patients) - Download & Print
New Patient Letter - Download & Print
Patient Questionnaire (Required for New Patients or patients not seen over 3 years) - Download & Print
HIPAA Forms (Required for New Patients) - Download & Print
Office Policy (Required for New Patients) - Download & Print
If you would like to have medical records either sent from or to our office, please complete the medical records release:
Medical Records Release Form - Download & Print
For our patients who are being referred for a balance issue, brain injury, autism or a neurological disease, please complete the following document:
TBI Questionnaire - Download & Print
Our office has designed a map to each office as a courtesy to our patients. You can download the map and directions here:
To bill a non covered service from an insurance company, we need to have an Advanced Beneficiary Noticed signed by the patient. Please complete the following document:
Non-Covered Services Form (ONLY complete when requested by office staff) - Download & Print