Please print and complete each of these forms prior to your first visit. This will speed up your check in process and allow you to be seen as soon as possible.
If you have any questions regarding these forms please contact us.
Also please be aware that you may be asked to complete additional forms once you arrive for your appointment.
If you have any questions regarding these forms please contact us.
Also please be aware that you may be asked to complete additional forms once you arrive for your appointment.
| Patient Ocular and Medical History |
- Must be completed by all new patients
- Must be completed by all existing patients every 3 years
- If you have previous records of your eyeglass or contact lens prescription please have them faxed to our office before your appointment.
- If you have any old glasses (even broken pairs) or old contact lens boxes please bring them with you as well. We use this information to supplement your history.
| Speed Questionnaire |
- All patients must fill out this form before every comprehensive exam.
| Retinal Imaging Consent |
- All patients must fill out this form.
| Patient Responsibility Form |
- All patients must fill out this form.
- Please initial and date pages 1 and 2 and print, sign, and date page 3.
- A parent or legal guardian must sign this form for all patients under age 18.