Request Your Patient Portal Login Please submit one form per patient. "*" indicates required fields Patient Name* First Last Patient DOB* Month Day Year Which Location?*Select all that apply. Complete Eye Care (4250 NW Cache Road) Complete Eye Care Downtown (409 C Ave) Complete Eye Care Newcastle (918 NW 32nd) Email*We will send you access to your portal. Phone Number*We may text you for additional information.Is the patient a minor?*Minor is anyone under the age of 18. Yes No If answered YES, please enter your name and relationship.*If answered NO, please write N/A Request CommentsPlease do not submit any Protected Health Information (PHI).NameThis field is for validation purposes and should be left unchanged.