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Patient Forms

Here you will find access to our patient forms to save time at your next visit to Eyes on Main.

Our Forms


Revolution PHR


Revolutionphr utilizes the highest standards of online security while allowing you to view portions of your eye care record through any standard internet browser on a pc or mac computer.  We encourage you to use the login information created specifically for you to review the many features available.

The information currently available via the portal is broken down into five pods:

My Provider

  • Provides a summary of your doctor and practice information including address, phone number, and website

My Information

  • Provides a summary of patient information as recorded in your electronic health record including demographics and contact information

My Account

  • Provides a summary of financial transactions with the practice including current account balances and invoices

My Appointments

  • Provides a summary of upcoming appointments and allows access to documents and clinical information from past visits. Also allows you to request appointments; fill in your medical history questions prior to your visit, saving you valuable time.

My Orders

  • Provides a summary of product orders, their status, and delivery date


You can decide if access to revolutionphr is right for you, and participation is completely optional.  We have no record of your access and we allow you to use this online portal at your discretion.

To access the portal, contact our office to obtain your temporary username and password, then simply click the link below:

We genuinely hope that you find value in having access to this information in a timely and secure environment.  If you have any questions, please do not hesitate to contact us by phone 406.586.2173 or by email.