Patient Forms


person filling out form

Preparing for your Visit:

Prior to Your Appointment: Please complete and print the Patient history, HIPAA 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.

We Are Here For You
The safety of our patients, team members and our community is the highest priority at EyeHealth Northwest. Learn more about measures we are taking to keep you safe and what to expect during your visit.
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Our Locations

Aloha
18345 SW Alexander St,
Suite A
Aloha, OR 97003
(503) 642-2505 see more
Glisan
6701 NE Glisan Street
Portland, OR 97213
(503) 255-2291 see more
Gresham
24601 SE Stark St.
Suite 245
Troutdale, OR 97060
(503) 255-2291 see more
Hillsboro
6111 NE Cornell Rd
Hillsboro, OR 97124
(503) 846-9400 see more
Lake Oswego
9 Monroe Parkway, Suite 160
Lake Oswego, OR 97035
(503) 636-2551 see more
Milwaukie
11086 SE Oak St
Milwaukie, OR 97222
(503) 656-4221 see more
Mt. Tabor
5935 SE Division St.
Portland, OR 97206
503 777-5546 see more
Newberg
2318 Portland Rd, Suite 300
Newberg, OR 97132
(503) 538-1341 see more
Northwest Portland
1955 NW Northrup St
Portland, OR 97209
(503) 227-2020 see more
Oregon City
1306 Division St
Oregon City, OR 97045
(503) 656-4221 see more
Peterkort
9555 SW Barnes Rd.
#100 (1rst floor)
Portland, OR 97225
(503) 227-2020 see more
Providence Portland
5050 NE Hoyt St., Suite 445
Portland, OR 97213
(503) 231-0166 see more
Providence St. Vincent
9135 SW Barnes Rd., Suite 961
Portland, OR 97225
(503) 292-0848 see more
Southeast Portland
10819 SE Stark St,
Portland, OR 97216
(503) 255-2291 see more
Sunnyside
12050 SE Stevens Rd, Suite 100
Happy Valley, OR 97086
(503) 783-3300 see more
Tigard
15298 SW Royalty Parkway
Tigard OR 97224
(503) 227-2020 see more
Wilsonville
29250 SW Town Center Loop W
Wilsonville, OR 97070
(503) 582-0000 see more
Westside Surgery Center
13240 SW Pacific Hwy
Portland, OR 97223
(503) 639-6571 see more
EyeHealth Eastside Surgery and Laser Center
12050 SE Stevens Rd.
Happy Valley, OR 97086
(971) 206-6100 see more

Our Locations

Aloha
18345 SW Alexander St,
Suite A
Aloha, OR 97003
(503) 642-2505 see more
Glisan
6701 NE Glisan Street
Portland, OR 97213
(503) 255-2291 see more
Gresham
24601 SE Stark St.
Suite 245
Troutdale, OR 97060
(503) 255-2291 see more
Hillsboro
6111 NE Cornell Rd
Hillsboro, OR 97124
(503) 846-9400 see more
Lake Oswego
9 Monroe Parkway, Suite 160
Lake Oswego, OR 97035
(503) 636-2551 see more
Milwaukie
11086 SE Oak St
Milwaukie, OR 97222
(503) 656-4221 see more
Mt. Tabor
5935 SE Division St.
Portland, OR 97206
503 777-5546 see more
Newberg
2318 Portland Rd, Suite 300
Newberg, OR 97132
(503) 538-1341 see more
Northwest Portland
1955 NW Northrup St
Portland, OR 97209
(503) 227-2020 see more
Oregon City
1306 Division St
Oregon City, OR 97045
(503) 656-4221 see more
Peterkort
9555 SW Barnes Rd.
#100 (1rst floor)
Portland, OR 97225
(503) 227-2020 see more
Providence Portland
5050 NE Hoyt St., Suite 445
Portland, OR 97213
(503) 231-0166 see more
Providence St. Vincent
9135 SW Barnes Rd., Suite 961
Portland, OR 97225
(503) 292-0848 see more
Southeast Portland
10819 SE Stark St,
Portland, OR 97216
(503) 255-2291 see more
Sunnyside
12050 SE Stevens Rd, Suite 100
Happy Valley, OR 97086
(503) 783-3300 see more
Tigard
15298 SW Royalty Parkway
Tigard OR 97224
(503) 227-2020 see more
Wilsonville
29250 SW Town Center Loop W
Wilsonville, OR 97070
(503) 582-0000 see more
Surgery Centers

Westside Surgery Center

13240 SW Pacific Hwy
Portland, OR 97223
(503) 639-6571 see more

EyeHealth Eastside Surgery and Laser Center

12050 SE Stevens Rd.
Happy Valley, OR 97086
(971) 206-6100 see more