Patient Forms
If you are a new or returning patient please fill out page 1, 2, 3 and bring to your annual GENERAL EYE EXAM/ Annual Eye Exam appointment.
If you are coming in for brief office visits, please fill out just page 3, the Covid-19 Prescreen.
If you have already completed the patient forms sent to you via text/email, you DO NOT need to fill these forms out.
If you are coming in for brief office visits, please fill out just page 3, the Covid-19 Prescreen.
If you have already completed the patient forms sent to you via text/email, you DO NOT need to fill these forms out.

Patient Questionaire pg1 | |
File Size: | 644 kb |
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Patient Questionaire pg2 | |
File Size: | 597 kb |
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COVID-19 Pre-Screen Questionaire pg3 | |
File Size: | 67 kb |
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Notice of Privacy Practices/ Information | |
File Size: | 46 kb |
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Optomap Information | |
File Size: | 451 kb |
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Release of Records Request (for us to get your old records/outside rx) | |
File Size: | 33 kb |
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Release of Records Request (for us to release your record/rx to another office) | |
File Size: | 32 kb |
File Type: |