Poulsbo Eyecare Center
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Patient Forms

If you are a new patient, or if it has been over 3 years since your last visit, you will need to fill out paperwork before seeing the doctor.  You can choose to fill out the online forms, or print and bring in paper versions.

If you have a patient portal account, you can also update your paperwork by logging in to the portal and clicking "Forms."
Up-loadable Patient Information Form
PRINTABLE PATIENT INFORMATION FORMS
documentos imprimibles de informacion del paciente
If you need us to forward your records, please print and fill out the Authorization form below. You can fax the completed form to 360-779-7628, or mail it to 19220 8th Ave NE, Ste A, Poulsbo WA 98370.  Please note that our office e-mail is not secure; sending any Personal Health Information by e-mail is not recommended.
Printable Authorization for release of health information
Contact Us:
Ph: 360-779-2336
​Fax: 360-779-7628
​[email protected]
Hours:
Monday-Thursday 8:00 am-5:00 pm
​Fridays 8:00 am-3:00 pm
Location:
19220 8th Ave NE, Ste A
Poulsbo, WA 98370
​
Notice of Privacy Practices
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Eyefinity
  • Home
  • Appointment Request
  • Optical Shop
  • New & Current Patients
    • Patient Portal
    • Patient Forms
    • Billing & Insurance
  • About Us
    • Meet The Doctor
    • Our Services
    • Location