Forms

Online Form

Printable Forms

What Forms Do I Download?

After you have called our office to schedule your appointment, please click on the “Online Patient Form” link and follow the directions for a new Patient. If you are a returning patient, we will provide you with a pass-code to update your existing information.

Please remember to fill out all three tabs: DEMOGRAPHICS, INSURANCE and MEDICAL HISTORY before you click “submit”.

This information will be imported directly into your medical record so it is available on the day of your visit, saving you valuable time in the office. This also gives you an opportunity to tell us about you or your child in great depth. This information is very helpful for us to review ahead of time and we appreciate you filling it out well in advance of your appointment.

Included in this Medical History are the following Sections.

  • VISION AND EYE HEALTH HISTORY
  • PEDIATRIC HISTORY (for children 12 years of age and younger)
  • SCHOOL RELATED HISTORY (for students)
  • READING AND COMPUTER SYMPTOM CHECKLIST (for children and adults)
  • DRY EYE HISTORY
  • BRAIN INJURY HISTORY (stroke, head injury, concussion, whiplash, motor vehicle accident, bike accident, etc.)
  • VISION MOTION SENSITIVITY CHECKLIST (Dizziness, motion sickness, car sickness, etc.)
  • SPORTS VISION HISTORY (Professional athletes and weekend warriors)

Please complete all sections which are appropriate for you or your child. You are welcome to skip any question if you do not know the answer.

This electronic method of submitting vision and eye health information is completely encrypted and secure utilizing our Practice Management Software’s Server. If, however, you are uncomfortable sending your information over the internet, please print the “Printable Patient Form” and Fax it to us at 541-342-6153 or bring it with you to your appointment.

If you need records sent to us, please print the “Printable Records Release” and fill it out. When you fax or deliver this release form to your previous or referring doctor, they will forward the records you request to our office.

To review our privacy practices, please click on the “Privacy Practices” link. You will be asked to sign a consent form when you arrive for your appointment indicating that you have had an opportunity to review this form.

Thank you for helping us prepare for your examination. We look forward to seeing you shortly at Lifetime Eye Care.