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 |
| Patient Questionaire pg2 |
| COVID-19 Pre-Screen Questionaire pg3 |
| Notice of Privacy Practices/ Information |
| Optomap Information |
| Release of Records Request (for us to get your old records/outside rx) |
| Release of Records Request (for us to release your record/rx to another office) |