Forms

Our patient registration form, medical history questionnaire, and privacy policy are available online.  To help you save time and fill in the correct information, you may print copies to fill out before your visit:

• Patient Registration Form

• Medical History Questionnaire

• Notice of Privacy Practice

To either transfer medical records from another office to the Eye Clinic of Bellevue or to transfer records from our office elsewhere, please fill out the following form:

• Authorization to Use or Disclose Health Care Information

Abobe Acrobat Reader is required to view and print online forms. Click here to download Acrobat Reader (free download).