Online Forms

At Liberty Lake EyeCare Center, 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.

The Telehealth Visual Acuity Chart

Please click on the chart below to download the full image, print it, and attach to your wall.


Online Form

New Patient Health History Form – Required

Click and Fill out the online form


Downloadable Forms


New Patient Health History Form - Required

Download & Print Form

Authorization for Release of Information to Family Members - Required

Download & Print Form

Liberty Lake EyeCare Center Policy - Required

Download & Print Form

Demographics Form - Required

Download & Print Form

Download the Free AdobeReader®

Exclusive Offer

Receive 20% off any 2nd pair of glasses for all patients.

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