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Important Forms

Please complete the forms below by printing them and filling them out by hand. They may also be filled out electronically, using a computer, tablet or mobile device, and then sending them directly to our office via the email button at the bottom of each form.  Please be sure forms are completed and returned to our office as soon as possible, prior to your visit.  Thank you!

Please do not forget to bring or send any other pertinent information i.e. x-rays, lab work, and/or office notes from your referring physicians and/or other facilities.


*Required to be filled out by all new patients (or anyone who hasn't been seen in our office in past 3-years).

Release of Healthcare Information

Individuals who have been a patient at Oregon Trail Eye Center, P.C. have the right to access or receive copies of their medical records. Authorization for Release of Health Care Information forms can be obtained at the front desk Monday through Friday, 8:00am – 5:00pm or you may print them from links below, fill them out and fax to (308) 635-3130, email to or return them to our office by mail or in-person:


Oregon Trail Eye Center P.C.

329 West 40th Street   

Scottsbluff, NE 69361

The following documents are strictly for informative purposes and can be printed and kept for your files:

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