Patient Forms
EDOW is proud to offer you the best technology in all aspects of our practice, including our electronic medical record (EMR) system. When you come in for your appointment, we ask that you fill out our patient forms at our simple-to-use kiosk. You can review the forms below, but there is no need to print them for your appointment.
- Financial Responsibilities
- Use and Disclosure of Protected Health Information
- Signature on File, Assignment of Benefits, Financial Agreement
Laser Vision Correction Patients
Please review the following forms before your initial evaluation, although there is no need to print and bring them to your appointment:
Medical Records Requests
To obtain a copy of your medical records*, please download the following release form for the correct location.
- Medical Records Release TO Eye Doctors of Washington
- Medical Records Release FROM Eye Doctors of Washington
The form may be sent via e-mail to medicalrecords@www.edow.com or fax to: 202.688.2857
*Please inquire about the fee for obtaining a copy of your medical records.
Motor Vehicle Eye Exam
EDOW charges a $25 fee for paper or electronic vision screening forms. If the patient requests this form to be filled out during a scheduled appointment with their doctor, the EDOW fee is waived.
