Serving the Willamette Valley!

Our Location
3783 International Ct. Suite 160 Springfield, OR 97477

Call Us
(541) 726-5055

Patient Forms

At EyeCare Focus & Specialties, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReaderĀ® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

Electronic Health Records

Access Secure Patient Forms


Registration Form (New Patient)

Download & Print Form


Registration Form (Previous Patient)

Download & Print Form


Medical History Questionnaire

Download & Print Form


Elective Optomap Consent Form

Download & Print Form


Privacy Policy Information

Download & Print Form


Download the Free AdobeReaderĀ®

If you Have Any Questions We are Here!! DON'T HESITATE TO CONTACT US ANY TIME.