Patient Forms

Patient Forms

Please click on the link below labeled “New Patient Forms” and print them. Complete the forms to the best of your ability and bring them with you to your visit. We look forward to seeing you soon.

DILATION/REFRACTION FORM

MEDICAL HISTORY FORM

PATIENT INFORMATION FORM

HIPAA

CONTACT LENS ORDER FORM

DISCLAIMER

I understand I can email the office for appointments, however, communications via email over the internet are not secure.  I should not include Personally Identifiable Information (PII), such as date of birth, home address, cell phone number, and never medical information – Protected Health Information (PHI), in my email correspondence.