Eastside Family Vision Care

Please choose the correct forms.  Please print each form, complete, and sign prior to your visit, even if the form does not apply. Bring these completed forms with you to help us serve you faster.

Adults - Premera Microsoft

   1) Adult Registration Form

   2) Communication Agreement

   3) COVD Questionnaire for Adults

   4) HIPPA Agreement

   5) Premera Microsoft Insurance Form

Adults - Other Insurance

   1) Adult Registration Form

   2) Communication Agreement

   3) COVD Questionnaire for Adults

   4) HIPPA Agreement

   5) All Other Insurances Form

Children - Premera Microsoft

   1) Children's Registration Form

   2) Communication Agreement

   3) COVD Questionnaire for Kids/Teens

   4) HIPPA Agreement

   5) Premera Microsoft Insurance Form

Children - Other Insurance

   1) Children's Registration Form

   2) Communication Agreement

   3) COVD Questionnaire for Kids/Teens

   4) HIPPA Agreement

   5) All Other Insurances Form