Forms

In order to make your next visit with us as efficient as possible, please take a moment before your scheduled appointment to print and complete the following patient forms:

• Medical History – The information requested in this form better allows our physicians to care for you and must be updated annually. Please fill out before your next visit and also include a list of current medications.
• Today’s Eye Exam: Vision vs. Medical – Please read carefully, initial applicable boxes and sign at the bottom.
• Why Does OES Ask For My SSN and ID? – Every time you come in for an appointment our clinics will need to appropriately identify you, as will many insurance companies we may bill on your behalf. Please read this form carefully for a detailed explanation on why we request specific identification.
• Records Release Form  (If applicable) – In some cases, Oregon Eye Specialists may need your primary care physician to share pertinent medical information with us which requires your authorization. Please fill out if this situation applies to you.
• Authorization to Examine Minors (If applicable) – Unless a court has stated otherwise (and a formal legal document can be provided to us), the parents listed on the birth certificate are the only people allowed to approve medical care being provided to a child. If a parent or LEGAL guardian is not bringing the child to his/her appointment, then we need permission from the parent that we can see that child. Please complete the information to authorize us to see your child with the following people you would like to be able to bring your child to appointments.

If you prefer, we also welcome you to complete these forms in our office by arriving 10-15 minutes early to your next scheduled appointment.

For your convenience, our Privacy Practices Notice is available online to read before your next visit. If you are unable to do so before arriving, hard copies are also available in our clinic.