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Practice Name

elemental eyecare

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Primary Location
2736 NW Crossing Drive, Ste. 120
Bend, OR 97703
Phone: (541) 323-3937
Fax: (541) 323-3938

Office Hours

SaturdayBy Appt.Closed
Main Content

What Forms Do I Download?

We try our best to save paper and time.  Please support us in this endeavor and complete as much paperwork online as possible.

After you have scheduled an appointment, please click on the "Personal Information" link and follow the directions for a new patient.

If you are a returning patient, we will provide you with a pass-code to update your existing information.

Please remember to fill out both tabs: DEMOGRAPHICS and MEDICAL HISTORY, before you click "submit".

If you need records sent to us, please print the "Records Release", fill it out and fax it to your previous or referring doctor.

All patients must consent to our privacy practices. You will be asked to sign a consent form when you arrive for your child's appointment. In order to review our privacy practices, please click on the "Statement of Privacy Practices - HIPAA" link.  There is no need to print this.

Online Forms:

Personal Information

Secure Patient Portal:

click here

Printable Forms:

Records Release

Statement of Privacy Practices - HIPAA

Teacher Observation Checklist

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2736 NW Crossing Drive, Ste. 120
Bend, OR 97703

(541) 323-3937

Fax: (541) 323-3938

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