Patient FormsIt is always our goal at West Michigan Eyecare Associates to give you the eye care you deserve in a timely manner.

In order to ensure that your first visit goes smoothly, you may want to complete the forms below prior to your visit. If you print hard copies of this paperwork, please bring it completed to your appointment.  Thank you for helping us prepare for your appointment.

New Patient Form – (eForm – submit online for adults or children)
New Patient – Adult (PDF – download and print)
New Patient – Pediatrics (PDF – download and print)

Notice of Privacy Practices (PDF – download and review)  We value patient privacy and do all we can to protect your information.  Please review our Notice of Privacy Practices to be informed about how we may use or disclose your protected health information.

Privacy and Financial Policies Agreement (PDF – download and print)  This form notifies you of our Financial Policies and summarizes our Privacy Practices.  Please bring this completed form with you to your first visit.

 

Records Release Forms

Please complete the appropriate form below and email (yourteam@wmeyecare.com) or fax (616-949-2878) to us to begin the process to transfer your medical records.

Transfer of Medical Records to Our Office
PDF download and print or Submit online

Transfer of Medical Records From Our officePDF download and print or Submit online

 

You will need Adobe Reader® installed on your computer. If you don’t have it, click here to download it. Click Here to download.

If you have any questions about our office or our forms, don’t hesitate to contact us today at (616) 949-8500.