Office Forms

If possible, please download (“save”) the following forms, and complete the Health History Form & Authorization for Information Release, and bring the completed forms with you at the time of your appointment. Alternatively, you may FAX them to us at 425-377-8757 at any time prior to your appointment.

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Please identify any medical condition(s) which you or your close relatives may have. Please make an X for any body system in which you have had or currently have a diagnosed disease &/or symptoms…

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I voluntary consent to and authorize my optometric physicians professional office named above to use or release my health information to certain recipients…