To help the doctor and staff devote the most possible time to you and your vision care, please download, complete, and bring all requested forms to your appointment or send them to us in advance to:
6800 North 79th Street, Suite 101
Longmont, Colordo 80503
or fax: 303 652-0606
Please bring appropriate information from other healthcare practitioners.
Please let us know if your child has special needs such as delayed speech, poor motor control, or is confined to a wheel chair. We can do modified exams but need time set up the exam room, or we may need to schedule a longer exam.
| Acknowledgement of Receipt of our Privacy Policy | HIPPA This form is required in all healthcare offices and acknowledges that our office will not release your records or any personal information without your written consent. |
| Authorization to Release Medical Information | If you choose to have a doctor or staff from our office communicate with any person outside of this office, that person outside of our office must be noted on a separate signed form. The form has options for a limited time release, or open-ended (until revoked). |
| Child History Form | This information is used by the doctor to better understand the child, the birth history, developmental milestones, school performance and specific problem areas of concern. |
| New Patient Information Form - Welcome to our Office | Basic contact, health and visual needs information for use by the doctor and staff during your visit. |
| Information for Traumatic Head Injury Clients | For TBI clients, especially those who have had an auto or vehicle accident, please fill in information as appropriate. |