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(361) 210-3522
Located in the Northshore Plaza Shopping Center
Important COVID-19 Safety Measures, We are Now Open!.

Home » About TSO In Portland » Welcome to the office of Dr. Robert M. Barton, Jr.

Welcome to the office of Dr. Robert M. Barton, Jr.

Thank you for choosing us for you eye care needs. We are delighted to have you as a patient and appreciate the confidence you have placed in us. Please take a moment to complete the following information. Any information we already have on file will appear on this form. Please review all completed areas to ensure that the information we have is current and accurate. If you have any questions, please do not hesitate to ask.
Appointment Date
Date Format: MM slash DD slash YYYY
Name
First Middle Last
Date of Birth
Date Format: MM slash DD slash YYYY
Social Security Number
Occupation
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Home Phone
Work Phone
Email Address
Spouse or Parent(s) Name(s)
Primary Care Doctor
Primary Care Dr. Phone Number
Person Responsible for Account
Responsible Party SS Number
Date of Birth
Date Format: MM slash DD slash YYYY
Employer/School
Responsible Party’s Employer
Responsible Party’s Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Work Phone
Preferred method of contact:
- Text
- Email
- Landline
IF NO CHANGES TO YOUR INFORMATION, PLEASE INITIAL HERE
Vision Insurance Information
Company
ID#
Group
Subscriber’s Name
Subscriber’s DOB
Date Format: MM slash DD slash YYYY
Subscriber’s Employer
Patient Relationship to Insured
- Self
- Spouse
- Child
Medical Insurance
Company
ID#
Subscriber’s Name
Subscriber’s DOB
Date Format: MM slash DD slash YYYY
Authorization for dilation
In the process of today’s examination, the doctor may recommend dilation for further examination of your eyes. Dilation may not be part of the routine examination, thus it may be an additional expense. If so, do you wish to be dilated today?
- Yes
- No
Authorization to Release Medical Information
I authorize Robert M. Barton, Jr. O.D. to release/request medical information on my behalf to/from any entity to assist in my medical care per my request. This assignment will remain in effect until revoked in writing.
- Yes
- No
Patient/Guardian Signature
Date
Date Format: MM slash DD slash YYYY

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Hours & Directions

Monday: 9:00 AM - 5:30 PM
Tuesday: 9:00 AM - 5:30 PM
Wednesday: 9:00 AM - 5:30 PM
Thursday: 9:00 AM - 5:30 PM
Friday: 9:00 AM - 5:30 PM
Saturday: Closed
Sunday: Closed

1540 Wildcat Dr
Portland, TX 78374

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TSO Portland - Located at 1540 Wildcat Drive, Portland, Texas 78374 Phone: 361-643-1516 https://www.portlandtso.com

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A Message to Our Patients

Our patients’ eye care needs are and always have been our top priority. With all that is happening, we are OPEN to help serve our patients. During this difficult time, we have made a few adjustments to our services and availability to ensure the health and safety of you, our staff and our Doctors.

For the Protection of Our Patients,
we have implemented the following procedures in our clinic:

Social Distancing - we are limiting the number of patients in our office and when possible, only one person per visit.
Limited Appointment Scheduling - in order to ensure that we are able to properly disinfect and adhere to Social Distancing Guidelines, please call ahead for an appointment.
Pre-Screening Questionnaire - anyone showing signs of illness including coughing, sneezing, fever, or general malaise or has taken Ibuprofen or Acetaminophen, will be asked to reschedule.
Face Coverings - we are requiring anyone entering our clinic to wear some type of facial covering, such as, a homemade mask, scarf, bandana, or handkerchief. Our staff is also wearing facial masks.
Curbside Service - we will bring your glasses or contacts out to your car. Call us when you arrive, let us know what you are picking up and what type of car you are driving. Sit tight and we will have your product delivered directly to your car.

Thank you for your support and understanding during these unprecedented times.

We hope to be able to continue to provide excellent care and service.

God Bless,

Robert M. Barton, Jr. O.D. and Staff