Patients
If this is your first appointment please complete the new patient packet for our records.
Please consider the following for your appointment:
- Your appointment can last 2-4 hours depending upon specialized diagnostic testing and possible treatment.
- Bring a snack or lunch, especially if you are diabetic.
- Please bring a list of current medications, current providers, and available medical records.
- Due to testing and possible treatment we recommend that a driver accompany you to your appointment.
We have partnered with MediCopy to fulfill your Release of Information requests and Disability/FMLA forms. MediCopy is fully HIPAA compliant and adheres to all state and federal regulations concerning release of medical information.
Medical Records
Patients can request copies of their medical records at no cost, but delivery fees apply for postage, so provide an email address! Please provide an email address on the authorization to expedite the process and delivery method. Records sent via email or to another provider are complimentary. Requests are completed within two (2) business days after receipt by MediCopy.
To request your medical records please fill out one of the following authorization forms:
● Authorization for the Release of Medical Records (Online)
● Authorization for the Release of Medical Records (Paper)
● Learn more about MediCopy’s Release of Information service
Disability/FMLA Forms
Forms are $30 for the first form and $15 for each additional form turned in at the same time. After payment is received, Disability/FMLA forms are completed and sent to the requestor within three business days.
● Authorization for the Release of Disability/FMLA form (Online)
● Authorization for the Release of DIsability/FMLA form (Paper)
● Learn more about MediCopy’s Form Completion service
If you have any questions, please contact MediCopy:
online chat: MediCopy.net | phone: 866-587-6274 | email: contact@medicopy.net
Service Animals
If you require an assistance of a service animal, please review our current policy prior to your appointment.
Diagnostic Testing
Persons visiting Retina Northwest solely for diagnostic testing should complete the following forms:
Patient Registration
Payment Policy
Privacy Practices Acknowledgment Form
Privacy Practices
It is Retina Northwest’s responsibility to protect your personal health information in accordance with applicable laws. Please take a moment to download or print a copy of our privacy practices form for your records. Copies are also available at all clinic locations.
Additional Resources:
The American Society of Retina Specialists
The American Academy of Ophthalmologists
Providence MyChart
Legacy MyHealth
In case of inclement weather, Retina Northwest will post clinic closure information under the Contact Us section.
