Request Your Patient Portal Login

Please submit one form per patient.

"*" indicates required fields

Patient Name*

First Last

Patient DOB*

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

If answered YES, please enter your name and relationship.*

If answered NO, please write N/A

Request Comments

Please do not submit any Protected Health Information (PHI).

Comments

This field is for validation purposes and should be left unchanged.

Complete Eye Care – Lawton