Welcome to Bengoa Eye Care!

Please download and complete the below New Patient Forms prior to your appointment.

New Patient Information Form

Contact Lens Agreement and Optos

HIPAA Acknowledgement:

• Please review this document for your reference. Printing or bringing a copy of the HIPAA Acknowledgement to your appointment is not necessary. Printed copies are available in our office upon request.

We request that the New Patient Information Form is completed ahead of your office visit - to deliver it, you can:

• Email the form back to us at info@bengoaeyecare.com

• Mail the form to our office at 1050 Hanson Street, Winnemucca, NV 89445

• Drop the form off at our office prior to your appointment

• Bring the form a few minutes prior to your appointment

What to Bring:

• Any vision and medical insurance cards

• Your current pair of eyeglasses (including non-prescription sunglasses, and reading glasses)

If you currently wear contact lenses, please arrive wearing your contacts, and bring your most recent contact lens Rx, or packaging showing the lens information.

Notice of Privacy Practices

Please review our NOTICE OF PRIVACY PRACTICES here.