Patient Center

Welcome to our Patient Center. Once you have scheduled an appointment we will need some additional information. Please fill out and submit the Online Patient Registration. Also, if you have access to a printer, please print and sign the HIPAA consent form and bring it with you to your appointment.

Online Patient Registration HIPAA – Download PDF

If you prefer not to fill out and submit the Online Patient Registration and have access to a printer, you may download and print the office registration, medical health questionnaire, and HIPAA consent forms and bring them with you.

Office Registration

Download & Print

Medical Health Questionnaire

Download & Print

HIPAA Consent

Download & Print

If you do not have access to a printer, we have printed forms available at the office.

We want your visit to be as stress-free as possible. Our staff will do everything we can to make sure your experience is pleasant and convenient. If you have any questions about these forms, please don’t hesitate to contact us.

Payment Options

Polsinelli Optometry believes in providing the best value for you and your family. We have products and pricing that aims to accommodate all budgets.

​We accept Cash, Personal Checks, Debit Card, American Express, Mastercard, Visa, and Discover.

​*We accept flexible spending and health savings accounts!*


​We currently participate with VSP, Medicare, MetLife, Cigna, First Choice Health, Providence Health Plan, Regence BlueCross BlueShield, Spectera, PacificSource Health Plans, Eyemed, United Healthcare, Aetna, Oregon Health Plan Medicaid, Kaiser Permanente North West, BridgeSpan Health, and Asuris Northwest Health.. We are currently credentialing with multiple insurances. Please contact our office if your insurance is not listed.

Please contact us today to schedule an appointment.
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Our Office

  • 4859 Meadows Road
  • Suite 155
  • Lake Oswego, OR
  • 97035
Contact Page Request an Appointment 

Office Hours

  • Monday
  • Closed
  • Tuesday
  • 9:00am - 6:00pm
  • Wednesday
  • 9:00am - 6:00pm
  • Thursday
  • 9:00am - 6:00pm
  • Friday
  • 9:00am - 6:00pm
  • Saturday
  • 10:00am - 3:00pm
  • Sunday
  • Closed
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