Forms

Patient Forms

If you’re a new patient, please take the time to fill out these forms before you visit us at Highline Vision Center, so that we can make your first appointment with us more enjoyable and personalized for your specific vision needs!

Child / Student New Patient History Form

Complete Child/Student Health Form Online
Download Child-Student History Form (PDF)

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Optomap: Highline Vision Center is excited to introduce the Optomap, a wide angle digital scan of the back of your eye.In most cases an Optomap image will replace the need for dilation. Many vision threatening conditions present without any signs or symptoms and can cause permanent vision loss. The Optomap will help evaluate the overall health of your retina, detecting eye diseases such as retinal tears, glaucoma, macular degeneration, and even cancer. (Optomap testing costs $39. Optomap plus MPOD testing – see right column – is $45)

Adult New Patient History Form

Complete Adult Form Online

Download – Adult History Form (PDF)

MPOD: Our doctors strongly recommend the QuantifEye macular pigment optical density (MPOD) measurement. Low macular pigment density is a risk factor for Age-Related Macular Degeneration (AMD) and can be related to poor night vision. AMD is the leading cause of vision loss in adults, currently affecting more than 15 million Americans. Its effects may be permanent and irreversible; however you can reduce your risk. (MPOD testing costs $15. MPOD plus Optomap testing – see left column – is $45.)