The Children's Eye Center
​Call (719) 574-1654

8890 N. Union Boulevard
Suite 205
Colorado Springs, Colorado 80920
719-574-5381 fax
Click For Map

  • Home
  • Doctors & Staff
    • Dr. Dave H. Lee, M.D.
    • Dr. Ellen R. Miller, M.D.
    • Dr. Rebecca Mets-Halgrimson, M.D.
    • Dr. Dean S. Bancroft, O.D.
    • Our Staff
  • Pediatric Eye Services
    • Amblyopia
    • Strabismus
    • Esotropia
    • Exotropia
    • Pseudostrabismus
    • Blocked Tear Duct
    • Cataracts
    • Myopia Management
  • Adult Strabismus
  • New Patients
    • What to Expect
    • How We Are Different
    • Forms
  • Optical Shop
  • Contact Us
  • Make A Payment

Forms

Before your first visit to our office it may be helpful to download the appropriate forms below in advance. Please click on each link to download the forms, read them carefully, fill them out completely and bring them with you to your appointment. We look forward to seeing you soon!
Pediatric New Patient Forms
Pediatric Medical History
File Size: 1043 kb
File Type: pdf
Download File

Info and Authorization
File Size: 2235 kb
File Type: pdf
Download File

Record of Disclosures
File Size: 90 kb
File Type: pdf
Download File

Adult New Patient Forms
Adult Medical History
File Size: 209 kb
File Type: pdf
Download File

Info and Authorization
File Size: 2235 kb
File Type: pdf
Download File

Record of Disclosures
File Size: 90 kb
File Type: pdf
Download File

Notice of Privacy Practices
Notice of Privacy Practices
File Size: 254 kb
File Type: pdf
Download File

Release of Information
Release of Info To Children's Eye Center
File Size: 152 kb
File Type: pdf
Download File

Release of Info From Children's Eye Center
File Size: 128 kb
File Type: pdf
Download File

The Children's Eye Center
8890 N. Union Boulevard, Suite 205
​Colorado Springs, CO 80920
719-574-5381 fax

​(719) 574-1654
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Copyright 2016, The Children's Eye Center in Colorado Springs  CO