Patient Forms

To help with the speed of appointment check-in, Christenson Vision Care has these forms available for download.

• Patient Information Form 12- : This is for children 12 years and under. It is 2 pages and both must be completed each year.
• Patient Information Form 13+ : This is our adult form for patients who are 13 years or older. It is 2 pages and must be completed each year.
• Quality of Performance Survey :  This form should be filled out by those patients who are interested in vision therapy.
• Release of Personal Health Information : This form is for patients who have requested that we send or receive medical information to or from another doctors office.
• HIPPA Policy : Our policy on privacy practices and patient's rights.