Eberhardt Vision Center
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Patient Forms

Patient Forms


HIPPA English
File Size: 478 kb
File Type: pdf
Download File

HIPPA Español
File Size: 232 kb
File Type: pdf
Download File

We are required to provide you with this information concerning our Notice of Privacy Practices.
Please read this before you come to your appointment and let us know if you have any questions pertaining to this information, your rights, and our responsibilities.  Thank you.

Please print these four pages and bring with you to your appointment in our Mount Vernon or Arlington office.
Mount Vernon New Patient Form
File Size: 1692 kb
File Type: pdf
Download File

Mount Vernon New Patient Form SPANISH
File Size: 1814 kb
File Type: pdf
Download File

Mount Vernon Minor Consent Form
File Size: 57 kb
File Type: pdf
Download File

Mount Vernon Minor Consent Form SPANISH
File Size: 51 kb
File Type: pdf
Download File

Arlington New Patient Form
File Size: 1709 kb
File Type: pdf
Download File

Arlington New Patient Form SPANISH
File Size: 1745 kb
File Type: pdf
Download File

Arlington Minor Consent Form
File Size: 58 kb
File Type: pdf
Download File

Arlington Minor Consent Form SPANISH
File Size: 50 kb
File Type: pdf
Download File

Eberhardt Vision Center
1427 N. LaVenture Road
Mt. Vernon, WA 98273
Phone: (360) 424-0553

Mount Vernon Clinic Hours
Monday     9am-6pm
Tuesday    9am-6pm
Wed           9am-6pm
Thurs          9am-6:pm
​Friday         9am-6pm
Closed Daily for Lunch
​
1:00-2:00 pm
Arlington  Vision Center
524 N. Macleod Avenue
Arlington, WA 98223
Phone: (360) 435-2043

Arlington Clinic Hours
Monday     9am-6pm
Tuesday    9am-5:30pm
Wed           9am-6pm
Thurs          9am-5:30pm
Friday         9am-5:30pm
Closed Daily for Lunch
1:00-2:00 pm

  • Home
  • Our Practice
  • Locations
  • Our Services
    • Promotions
  • Patient Forms
  • Eye Care Articles
  • Informacion en Espanol
    • Nuestros Servicios
    • Pagos y Aseguranzas
    • Promocion de Otono
    • Promocion de Contactos