At North Coast Eye Care, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.
- You will need AdobeReader® to download and complete the forms. Click here to download.
- Download the required form(s). Print out the form(s) and complete the required information.
- Fax, email or bring your printed and completed form(s) to our office.
New Patient Health History Form – Required
Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.
Receipt of Privacy Practice and Consent to Disclose Medical Information - Required **review notice below**
Notice of Privacy Practices North Coast Eye Care LLC - Please read, these are your rights as our patient!
Patient Medical and Financial Responsibility Agreements - Required
Outgoing Records - HIPAA Release Form
Incoming Records - HIPAA Release Form
Refund, Return, and Cancellation Policy