Patient forms – Hope Clinic in Bellevue, Silverdale and Tacoma

New Patient Forms

Please print out the appropriate FORMS for your case (or as many cases apply if you’re applying for more than one person). You will need the age-appropriate “Information Packet” along with the accompanying age-appropriate “Medical History.”

Please take a moment to read our Privacy Practices, and then sign and date the HIPAA Privacy Policy section in the Information Packet. Please bring your filled-out form to your appointment.

Ages 0 – 12
“Child” Information Packet plus the “Child” Medical History Forms
Ages 13 – 17
“Young Adult” Information Packet plus the “Young Adult” Medical History Forms
Ages 18+
“Adult” Information Packet plus the “Adult” Medical History Forms

Contact Hope Clinic to begin the process of learning how Vision Therapy can help you or your child! Hope Clinic offers two online options: Schedule a Free Screening or Schedule a Full Functional Vision Evaluation, or call us at (425) 462-7800.