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Patient Forms

Patient Forms:

For your convenience, you can download forms and fill them out to bring to your scheduled appointment.

For new patients and patients who haven't been seen in more than 3 years,

please fill out Patient Registration Forms (3 pages).

Please refer to Notice of Privacy Practices.
 

 

Medical Records Request:
If you are requesting our office to release your medical records, please fill out

the Medical Records Release Form and email it to admin@kennethmortonmd.com.

We will release chart notes of your last three visits. Options are:

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1. Transfer to Your New Eye Doctor
There is no records release fee charged for transferring medical records directly to another healthcare provider.

  • Processing Time: Please allow 5 to 7 business days for your records to be transferred once we receive your request.

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2. Release to Yourself
A $6.50 processing fee applies to all medical records requests released directly to the patient. Once we receive your request, we will send a secure invoice via Square with a direct payment link.

  • Delivery: Your records will be sent via encrypted email once your payment is processed.

  • Processing Time: Please allow 5 to 7 business days after we receive both your request and payment.

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*Note: Square is a secure, widely used payment platform. You do not need a Square account to pay your bill.

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© 2018 Eastside Eye Consultants

9 Lake Bellevue Drive, Suite 105 Bellevue, WA 98005

Tel: 425-562-6135

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