CLEAR VIEW EYE ASSOCIATES
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  • Our Practice
  • Specialties and Services
    • Comprehensive Eye Exams
    • Dry Eye Education and Treatments
    • LipiFlow
    • Blepharitis and Demodex
    • Emergency Services
    • Surgical Vision Correction Procedures
    • Eye Care Articles
  • Fashion Eyewear
    • Prescription Lens Technology
  • Information for Patients
    • What to Bring to Your Visit
    • Forms
    • Policies
    • Insurance and Payment Information
  • Locations and Hours

forms

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. 
​
Patient Ocular and Medical History
File Size: 193 kb
File Type: pdf
Download File

  • 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
File Size: 105 kb
File Type: pdf
Download File

  • All patients must fill out this form before every comprehensive exam.
     
Retinal Imaging Consent
File Size: 156 kb
File Type: pdf
Download File

  • All patients must fill out this form.
     
Patient Responsibility Form
File Size: 267 kb
File Type: pdf
Download File

  • 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.

Contact us


550 Main St. 
Woburn, MA 01801
Phone: 781 - 935 - 1025
Fax: 781 - 933 - 6110
8 Andover Rd.
Billerica, MA 01821
​Phone: 978 - 663 - 3100 
Fax: 978 - 663 - 1490
Notice of Privacy Practices
Website by Eyefinity

Our web site is meant as a patient education and information resource and strictly does not provide medical advice, suggestion, or a diagnosis.
The material contained on this site is not intended to be a substitute for professional medical advice, diagnosis, or treatment. 
Each case is unique and must be handled by a professional. Always seek the advice of your physician or other qualified health care provider.

All videos and images are the property of their respective creators and do not belong to Clear View Eye Associates, P.C.

If you have questions regarding anything you have seen here please call us, we are happy to help!
  • Home
  • Our Practice
  • Specialties and Services
    • Comprehensive Eye Exams
    • Dry Eye Education and Treatments
    • LipiFlow
    • Blepharitis and Demodex
    • Emergency Services
    • Surgical Vision Correction Procedures
    • Eye Care Articles
  • Fashion Eyewear
    • Prescription Lens Technology
  • Information for Patients
    • What to Bring to Your Visit
    • Forms
    • Policies
    • Insurance and Payment Information
  • Locations and Hours