Patient Forms
Access our patient forms that you can fill out before your next visit to Coos Bay Vision Center in Coos Bay.
Our Forms
- Welcome Letter [PDF]
- Patient Information Form [PDF]
- Medical Records Release [PDF]
- Vision Records Release [PDF]
- Authorization for Release of Identifying Health Information [PDF]
- Contact Lens Fee Form [PDF]
- Acknowledgment of Notice Of Privacy Practices [PDF]
- Notice of Privacy Practices [PDF]
- Notice of Nondiscrimination [PDF]
- The Right To Receive Communication Assistance [PDF]
Upcoming Telemedicine appointment? Please read this: How to check in for your video visit[PDF]