Patient Forms

The clearest choice for Loveland, Windsor, Fort Collins & nearby areas of Colorado

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Helpful Information

We are pleased and grateful that you have chosen Kirk Eye Center for your eye care needs. We would like to welcome you to our practice. At Kirk Eye Center, our patients are our primary focus.

If your first visit is to be for a routine eye exam, you may find it helpful to read the detailed description of what is involved in your comprehensive medical eye exam. You can access that document below, under the Your Comprehensive Eye Exam link.

In addition to accepting insurance payments,  Kirk Eye Center also accepts the popular CareCredit healthcare card for services. You, too, can discover the many benefits of healthcare financing with the CareCredit healthcare credit card. If you don’t already have one, you can apply here!

Apply for CareCredit Healthcare Card HERE

Insurance Plans Accepted

  • AARP
  • Aetna
  • Blue Cross-Blue Shield
  • Cigna
  • Humana
  • Kaiser Permanente  (Northern Colorado)
  • Medicare
  • Medicaid
  • Rocky Mountain Healthcare
  • United Healthcare
  • VSP

Before Your Visit

Prior to your first visit, we ask you to access and prepare several forms, located on this page. You can print the forms in the convenience of your home, read them thoroughly at your convenience, complete them, and bring them to your first visit. We can assist you as to the forms that need to be completed and submitted. Doing so, will not only save you time, it will allow us to focus on you and your quality of care.

If there is insurance for your professional care and service, Kirk Eye Center has regular billing arrangements with any number of companies. You can verify yours by simply calling, or asking when you visit.

New Patient Forms

If you are a NEW PATIENT at the Kirk Eye Center, please click on the links below to open the form that you may print, fill out and bring to your appointment OR you may complete the forms online and print it out and bring it with you.

Please note: If you fill out these forms online, the completed forms cannot be saved, however they CAN be printed.

Medical Record Release Form

Minor Permission to Treat Form

Registration Form

Financial Policy Form

Refraction Policy Form

New Contact Lens Patient Forms

If you are a new contact lens patient at the Kirk Eye Center, please click on the links below to open the form that you may print, fill out and bring to your appointment OR you may complete the forms online and print it out and bring it with you.

Please note: If you fill out the forms online, the completed forms cannot be saved, however they CAN be printed.

New Contact Lens Patient Form

Registration Form

Financial Policy Form

Refraction Policy Form

Release of Medical Records

Use the attached form if you would like to have your medical records released from your current eye care provider, or if you would like Kirk Eye Center to release your medical records from our practice.

Please note: If you fill out the form online, the completed form cannot be saved, however it CAN be printed.

Click Here for Medical Records Release Form

Permission to Treat Minor

Use the attached form to grant us permission to treat your minor dependent.

Please note: If you fill out the form online, the completed form cannot be saved, however it CAN be printed.

Click Here for Permission to Treat Minor Form