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Online Forms

At Cottage Grove Eye Care, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReader® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

General Medical History - REQUIRED

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Download & Print Form


Authorization To Transfer Medical Information - OPTIONAL
(ONLY NEEDED FOR REQUESTING OR SENDING RECORDS TO OR FROM ANOTHER CLINIC.)

Download & Print Form


HIPAA Privacy Form - REQUIRED

Download & Print Form


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