Forms

Welcome to Lakes Family Eyecare

Our mission is to provide you with excellent vision care and quality eyewear.

New Patients:

At your initial check in we will have you fill out three forms:
1. Patient Information Form
2. Patient History Form
3. Notice of Privacy Practices/HIPAA

For your convenience these forms are attached and can be printed out and completed ahead of time. This will speed up your check-in process at your initial visit. If it does not work to complete these forms ahead of time please arrive at your appointment 15 minutes early to complete these in office. Thank you!

4. If you would like us to obtain your records from a previous clinic, we would also need you to fill out an “Authorization to Release Information”. That form is attached here.

All Patients:

Attached is a copy of our Privacy Practices (HIPAA Notice).

Please feel free to print a copy of this for your records. If you have any questions regarding your patient information feel free to contact our office at (218) 346-3073.