Patient Forms

At Christenson Vision Care, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax (715-381-5357) us your printed and completed forms or you may bring them during your visit.
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  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us (715-381-5357) your printed and completed form(s) or bring it with you to your appointment.

Patient Forms

Patient Intake Form

To save time, patients can prepare their paperwork before the appointment. Simply print out and complete the patient history form and bring it with you to your appointment along with your old eyewear, insurance card and photo I.D.

Patient Intake Form- English


Care Credit Application

When to update and upgrade your eyeglasses should be the question, not how are you going to pay for it. To make that decision even easier for our patients, we offer the CareCredit ® card.  We partner with CareCredit to provide financing options to our patients. CareCredit is a payment option specifically for healthcare needs. You can use CareCredit for exams, contact lenses, and even eyeglasses.  CareCredit lets you upgrade your eyeglasses or contact lenses and then pay for them over time with low monthly payments that fit easily into your monthly budget. Now you don’t have to save up to get the eyewear you’ve always wanted.  CareCredit offers low minimum monthly payments and no up-front costs or pre-payment penalties.  To apply online, click the button below.

Care Credit Application


Quality of Performance Survey

This Form Should Be Filled Out By Those Patients Who Are Interested In Vision Therapy.

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Release of Personal Health Information:
This Form Is For Patients Who Have Requested That We Send Or Receive Medical Information To Or From Another Doctors Office.

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HIPAA Policy:
Our Policy On Privacy Practices And Patient’s Rights.

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