To help the doctor and staff devote the most possible time to you and your vision care, please do the following:
- Please click on this Link : https://www.crystalpm.com/index.jsp?crystalpmid=7225 fill out the forms and press submit.
- Please download, complete, and bring in the forms below to us at 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.
|Notice of Privacy Practices||This NOTICE OF PRIVACY PRACTICES (“NOTICE”) describes how we use or disclose your health information and how we can get access to such information. PLEASE READ IT CAREFULLY.|
|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).|
|Permission To Disclose Personal Medical Information||Please provide us with the telephone number you would like us to use when contacting you with regard to medical records, such as test results, treatment options, etc.|
|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.|