Eyecare Specialties of Northwest Colorado
For new patients. Please print out and complete this form. Also, prior to your initial visit, please go to the bottom of any page in this website and click on Notice of Privacy Practices. This information describes how we adhere to federal regulations regarding patient privacy. After you have reviewed this information, please sign the Acknowledgement of Receipt form which indicates that you have read and understand this policy. Please bring this form and a list of any medications (with dosages) you are currently taking to your first visit.
For parents of children aged 9 months to one year who are participating in the InfantSEE infant vision assessment program. Please print out and complete this form prior to your visit. More information regarding the InfantSEE program is available under the Promotions tab, left.
For new patients who wish to request their patient history from a previous eye doctor. Please print out and complete this form then fax to your previous eye doctor. If you need help determining your previous eye doctor's phone or fax number, we would be glad to assist you. Our office phone numbers are listed under the Locations tab, left.
For all Students (1st - 12th grades). A diagnostic questionnaire for patients to determine if your vision may be impacting your daily activities. Please print, complete and bring this form to your appointment.
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