~ WE LOOK FORWARD TO SERVING YOU! ~
Patient Forms
NEW PATIENTS & PATIENTS RETURNING AFTER 3+ YEARS (completion of patient forms are REQUIRED)
1. Please click on the button below to complete and submit REQUIRED forms securely online PRIOR to your scheduled appointment.
2. Please bring a valid picture ID (ie, drivers license, state ID) to your appointment.
3. Please bring ALL current Vision & Medical insurance card(s) and/or information (ie, Insurance name(s), member ID#(s), plan type(s))
4. Please be sure to Check-in 15-30 minutes prior to your appointment time for preliminary & any medical history work-up
CLICK THE APPROPRATE BUTTON BELOW TO COMPLETE YOUR FORMS:
1. Please click on the button below to complete and submit REQUIRED forms securely online PRIOR to your scheduled appointment.
2. Please bring a valid picture ID (ie, drivers license, state ID) to your appointment.
3. Please bring ALL current Vision & Medical insurance card(s) and/or information (ie, Insurance name(s), member ID#(s), plan type(s))
4. Please be sure to Check-in 15-30 minutes prior to your appointment time for preliminary & any medical history work-up
CLICK THE APPROPRATE BUTTON BELOW TO COMPLETE YOUR FORMS:
Required forms include:
CHILD: (1) Patient Information, (2) Office Policies, (3) HIPAA, (4) Insurance Disclaimer, (5) Student Questionnaire, (6) Contact Lens Exam
ADULT (18yrs+): (1) Patient Information, (2) Office Policies, (3) HIPAA, (4) Insurance Disclaimer, (5) Visual Health & Performance, (6) Contact Lens Exam, (7) OCT Screening
CHILD: (1) Patient Information, (2) Office Policies, (3) HIPAA, (4) Insurance Disclaimer, (5) Student Questionnaire, (6) Contact Lens Exam
ADULT (18yrs+): (1) Patient Information, (2) Office Policies, (3) HIPAA, (4) Insurance Disclaimer, (5) Visual Health & Performance, (6) Contact Lens Exam, (7) OCT Screening
PRINT OPTION (not recommended)
If our easy secure online forms option above is not desired, we have an option for printing and completing our BASIC Forms, Please download all three forms below and complete BEFORE your scheduled appointment. Please be sure to bring these forms with you at early check-in.
If our easy secure online forms option above is not desired, we have an option for printing and completing our BASIC Forms, Please download all three forms below and complete BEFORE your scheduled appointment. Please be sure to bring these forms with you at early check-in.
| PATIENT INFORMATION |
| PATIENT ACKN. & OFFICE POLICIES |
| NOTICE OF PRIVACY PRACTICES |
