BOX ELDER FAMILY VISION CLINIC
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Online Patient Forms


Save time during your appointment by completing our patient forms online. 
Below, you'll see the login page. (If this is your first visit, we'll take a few seconds to help you create a login to our site).
Secure Online Forms

Paper Forms

Though we encourage you to use our convenient online patient form above, you are welcome to download, print, and complete the below forms prior to your appointment. We look forward to seeing you!
Welcome to Office/ HIPAA
File Size: 141 kb
File Type: pdf
Download File

Reason for Examination
File Size: 98 kb
File Type: pdf
Download File

Medical History
File Size: 104 kb
File Type: pdf
Download File

Contact Us:
Phone: 435-723-2485
34 South Main Street
Brigham City, Utah 84302

Office Hours:
Mon, Tue & Fri: 10:00am to 5:00pm
Wednesday: 10:00 am to 8:00 pm
Notice of Privacy Practices
Website by Eyefinity
  • Home
  • Our Practice
  • Location
  • Services
    • Videos
    • Eye Care Articles
  • Patient Forms
  • Schedule Appointment