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Home ยป Welcome Form

Welcome Form

  • Please complete and read the information below. The patient registration form will be displayed once this form has been submitted
  • Date Format: MM slash DD slash YYYY
  • On behalf of Dr. Finley and Dr. Williams, we would like to say thank you for choosing Parkland Eye & Vision for your eye care and eye wear needs.
    On behalf of the team at Parkland Eye & Vision, and in an effort to give you the best patient care experience possible, we have streamlined our check in process to help reduce your wait time while in the office. If you will fill out ALL the requested information below, this will reduce your total time spent in our office. We have attached several important pieces of information that need your attention prior to your arrival for your appointment. Please take a few moments and complete all the paperwork attached.

    Upon completion of your paperwork, it will automatically and electronically be returned to us.

    For your convenience, we have outlined instructions for all the information needed prior to your appointment.

    1. Complete the Welcome Form and electronically sign the form when completed
    2. Complete the Financial Agreement and electronically sign
    3. Complete the Authorization for disclosure of patient health care information and e-sign (This gives us permission to discuss your health care information with persons that you specify on this form)
    4. Go to www.revolutionphr.com to complete your personal health history. Your username and temporary password are listed below:

    Username: THE EMAIL ADDRESS THAT YOU PROVIDED US AT THE TIME YOUR APPOINTMENT WAS SCHEDULED

    Password: If you cannot remember your password, please call the office and we will reset your password.

    5. Bring a list of all your medications with you to your appointment.
    6. Bring all your glasses and sunglasses with you to your appointment. We will want to see all your eyewear and sunwear.
    7. Bring your insurance card and ID with you to your appointment. You are welcome to contact us should you have any questions or need assistance with these forms by texting or calling the office at (253)537-7544. We look forward to seeing you at your upcoming appointment.

    Sincerely, Parkland Eye & Vision

For the latest COVID-19 office updates click here.