All Family Vision Care - Our Focus is on You! | HIPAA Release Form

Coming soon! We are excited to announce the opening of a new location in Bend, Oregon on May 6th! Stay tuned for more details! :)

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HIPAA Release

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Authorization to Disclose Health Information to Family Members and Friends

I authorize the release of health information to the individuals listed below:

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HIPAA Privacy Policy HIPAA Privacy Policy Acknowledgement: I acknowledge that I was offered a copy of Dr. Michael Klautzsch O.D., Dr. Justin Heintz O.D., and Dr. Kelly Shannon O.D. notice of privacy practices.

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Come in and see us at any of these four convenient locations!

Corvallis

All Family Vision Care

Tel: 541-757-8844

Portland

Raleigh Hills Vision Clinic

Tel: 503-297-1096

Sherwood

Eye Impressions

Tel: 503-625-0733

Salem

Salem Vision Clinic

Tel: 503-364-0767

Bend

All Family Vision Care Bend

Tel: 541-797-0295

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