Forms


**We are committed to keeping your personal information secure. All of our online forms are submitted via a secure connection and are HIPAA compliant.

Printable Forms

Please print and fill out the following forms.


*These forms require Adobe Acrobat Reader. Click the Adobe logo above to download.

***For Apple/Mac Users: You must use Adobe Acrobat Reader to submit the forms. To do so, simply right click on the form and save form. Open form in Acrobat Reader, fill out the form and submit.

Thank you for trusting us with your vision care.

Country Hills Eye Center

  • Country Hills Eye Center - 875 Country Hills Dr., Ogden, UT 84403 Phone: 1-888-393-2687

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