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New Patient Forms


Patient Forms:

Please complete and print the medical history, HIPAA and Payment Policy forms. Once you have completed the forms, please bring them with you on the day of your appointment. Due to privacy issues, please do not attempt to send these forms to our office via e-mail.

Patient History

Notice of Privacy Practices

HIPAA

Payment Policy

Records Release

 

Preparing for your Visit:

Prior to Your Appointment: Please complete and print the Patient history, HIPPA and payment policy forms even if you are an established patient. Once you have completed the forms, please bring them with you on the day of your appointment. Due to privacy issues, please do not attempt to send these forms to our office via e-mail.

Please check with your insurance company(s) to verify your “vision care” coverage for routine eye examinations by calling the customer service phone number listed on your insurance card. You may also call this same number to verify “medical” benefits for medically necessary visits and procedures.

The Day of Your Appointment:
Bring your current medical insurance card(s) with you.

  • The co-pay amount listed on your insurance card will be collected at the time of your visit.
  • For charges not covered by your individual insurance plan, payment is due at the time of service. Prompt pay discounts are available on certain services. Please ask at the front desk.

As part of your examination with us today, your pupils may be dilated. With dilation, most people experience light sensitivity and difficulty with near vision (such as reading). Some individuals also have difficulty seeing in the distance. The effects of the dilation can last several hours.

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OUR OPTICAL SHOPS

At EyeHealth Northwest, our Opticians are committed to helping you get the best pair of glasses you have ever had. Opticians are Nationally Certified by the American Board of Opticianry and participate in ongoing continue education courses to deliver the best possible care with the most advanced technology and fashion. We can take stress out of the process, making it enjoyable for you and your family.

With more than 60 years of experience in Portland, we are now driving the Portland look by designing and curating original frame collections based on our optical expertise - Bridge City Spex. We understand the importance of individuality, functionality, and quality. The Bridge City Spex Collections can be found exclusively at our eleven EyeHealth Northwest optical shops.

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