Tele-Med Examination Appointment Request

Name: Bison Vision Center
Address: 585 Murphy Rd., Medford, OR, 97504, US
Telephone: (541) 773-1414
Price range: $000 - $300

Please fill in the form below to request a Tele-Med Examination Appointment.
Name*
First Last
Phone*
Email*
Patient Type*
- New patient
- Returning patient
Has Occupational Therapy, Physical Therapy, Speech and Language Therapy been assigned?*
- Yes
- No
Name of Therapist
First Last
Facility
Phone
Email
Name of Therapist
First Last
Facility
Phone
Email
Name of Therapist
First Last
Facility
Phone
Email
Preferred Dates & Time*
Preparations For Appointment
- Download SKYPE to Your Cell Phone
- Provide Your Phone Number to bvc@hipaasecurity.us
Once I have this information, I will call to schedule our tele-med appointment.
Efforts to be in full compliance with constantly emerging federal, state, and Oregon Board of Optometry requirements to provide these TELE-MED services may cause delay contacting the patient .
I have developed a network of OT's who are hospital affiliated or in private practice to provide the follow-up therapy visits making In-patient, Outpatient, and Home Therapy options available.
I will do my best to guide you through this new and intimidating territory to be the best you can be.
Comments
Email
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Preparations For Appointment