New Patient Forms

 

These forms are provided for the convenience of new or established patients who have scheduled appointments. If you are a new patient or haven't been seen at the Spokane Eye clinic for two years or more please fill out these forms:

 

Patient Information Form

Health questionnaire

Release of Information HIPAA

Friends & Family Form - HIPAA

Notice of Privacy Practices FORM- HIPAA

 Request to Correct or Amend PHI form - HIPAA

Revocation of Authorization FORM- HIPAA

If your child is a new patient with a scheduled appointment to see Dr. Colburn or Dr. Weed, please fill out these forms:

 

Pediatric Patient Information

Pediatric Questionnaire