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Patient Information Form

New or Existing Patients

During your exam we will check the health of your eyes either by Optomap retinal imaging or dilating your eyes with eye drops.  Please review your options below to help decide which option is best for you.

Back of the Eye Showing Retinal Bleeds 02 color diabret 03 macular heme widefield | Coffman Vision Clinic in Bend OregonOptomap is the doctor’s preferred method to check your eye health and a convenient alternative that has no lasting side effects. It provides a digital image that can be used to track the history of your eye health. This service is offered for an additional $35.00.  Click here for more information on Optomap retinal imaging.

With dilation be prepared for light sensitivity and near vision blur for about 4 hours. Remember to bring sunwear and/or a driver if you feel it is necessary.  Dilation is included in the exam price.

We look forward to seeing you for your eye exam.  To help serve you better, please bring with you current glasses, sunwear, and/or contact lens information.  Also a picture ID, insurance cards, and medications lists.  Thank you!

Click here and complete the form before your eye exam or office visit.

This will save you time and make the office administration process easier.


If you have any other concerns or questions please contact us at 541-389-4774.