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]