La Pine Eyecare

patient information

Forms

Please print, complete, and bring the following forms to your appointment.

 Acknowledgement of Notice of Privacy Practices

  Patient History Form

  La Pine Eyecare Clinic Financial Policy

 LPEC Vision vs Medical Insurance

Optional form for records from your previous doctor

 Records Release

Click below to review our Notice of Privacy Practices and our Website Privacy Policy

Come See Us

Hours

Monday – Thursday 8:00am – 5:00pm (closed for lunch 12:00pm – 1:00pm)
Friday 8:00am – 2:00pm
Saturday & Sunday Closed

Address

16410 Third Street, Suite A
La Pine, Oregon 97739

Phone

(541) 536-2911