Online Forms

Basin Vision Center Online Forms

At Basin Vision Center, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax or email us your completed forms or bring them with you to your visit.

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Download the necessary form(s) and fill in the required information.
Fax or email us your completed form(s) or bring them with you to your appointment.

Basin Vision Center Online Forms

Medical History Form

Patient Intake Form

Notice of Privacy Practices

Acknowledgment of Notice of Privacy Practices

Medicare Benefit

Medicare Permission to File Secondary Insurance Form

Medicare Refraction Charge Form

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