Patient Center

Welcome to our Online Patient Center! Here you can get information about what to expect during your visit with our team as well as important forms you can complete before your appointment to save time.

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.

What to Expect

When you visit our office, you will be warmly welcomed and we can answer any questions you may have about completing the paperwork so that Lake Union Vision Clinic may see you. Our team will work together to evaluate your eyes and provide relevant eye care treatment information, review your vision benefits and payment options, fit you for glasses or contact lenses, and focus on exceeding all of your expectations. If at any time you have questions about the process or your specific health information, please ask.

Office Hours & Info

  • Monday
  • 7:00am - 5:00pm
  • Tuesday
  • 7:00am - 5:00pm
  • Wednesday
  • 7:00am - 5:00pm
  • Thursday
  • 7:00am - 5:00pm
  • Friday
  • Closed
  • Saturday
  • Closed
  • Sunday
  • Closed

  • 2121 Terry Ave, Ste 100
  • Seattle, WA 98121

New Patients

Please fill out the paperwork below and one of our trusted team members will be in touch to schedule your appointment. If you have any questions, please contact us and we’ll be happy to help!

Patient Forms

Please download and fill out each of the following forms or complete the forms online.

HIPAA Privacy Agreement

Complete OnlineDownload & Print

If you are interested in receiving a contact lens prescription, please also download and fill out the following form or complete the form online.

Contact Lens Evaluation

Complete OnlineDownload & Print
I happened upon this vision center. I stopped inside to check out a pair of frames. The selection was extensive but what impressed me most was the service! The staff listened attentively as I explained what I was looking for, I got help finding the perfect pair of glasses!!! I will definitely return!!!!!
Treva F.

Payment Options

Lake Union Vision Clinic believes in providing the best value for you and your family. We have products and pricing that aims to accommodate all budgets and our office participates in most insurance programs. For patients who have little or no vision insurance coverage, flexible payment programs may be arranged. To learn more about our payment options, please call our office directly.

Our office accepts cash, check, and major debit and credit cards including MasterCard and Visa.

Don’t forget to use your:

  • Flexible Spending Plans
  • Health Savings Accounts (HSA)
  • Medical Savings Accounts (MSA)
  • Cafeteria Plans for most of your eye care needs


Since there are so many plans and coverage varies widely, please call us to find out if your plan covers care in our office. Our staff will verify and explain your benefits before your visit at no charge.

Aetna, Cigna, First Choice, Premera, Regence, United Healthcare, Vision Service Plan (VSP)

If your insurance is not listed here, please call our office to verify.

All of the above plans can be used for all your eye care and eyewear needs, including eyeglasses, contact lenses, routine office visits and medical office visits.

Lake Union Vision Clinic