PATIENT ONLINE FORMS

Please make sure when filling out your forms that you fill out all appropriate forms completely and that you sign them if necessary. Also make sure you list all current medications completely including over-the-counters medicines (even if you have a medication list on file with us). These forms are sent to our office through HIPAA compliant methods and will allow us to have your medical chart ready upon your arrival for your appointment.

New patient exam/glasses

(4 forms total)

Please click on the buttons below to start filling out the forms.

Patient Information Form

Medical History Form

New Patient Dilation Form

Privacy Notice Form

Previous patient exam/glasses

(1 form total)

Please click on the buttons below to start filling out the forms.

Previous Patient Dilation Form

New patient

exam/contacts

(5 forms total)

Please click on the buttons below to start filling out the forms.

Patient Information Form

Medical History Form

New Patient Dilation Form

Privacy Notice Form

Contact Lens Agreement Form

Previous patient exam/contacts

(2 forms total)

Please click on the buttons below to start filling out the forms.

Previous Patient Dilation Form

Contact Lens Agreement Form

PATIENT PDF FORMS

We would prefer for patients to use the online forms submission to enable faster processing prior to patient arrival at the office. However, if you are unable for any reason to submit the patient forms online, there are printable PDF versions below that you may print and fill out before arriving for your appointment. If you choose this method you must arrive 15 minutes prior to your appointment time to allow the office staff time to prepare your medical chart (NOTE: Although you will be required to arrive early, due to COVID-19 guidelines you will not be allowed into the office before your scheduled appointment time). Please use the guidelines above for determining which forms you need to print and fill out.

New Patient Information Form

New Patient Medical History Form

New Patient Privacy Notice Form

New Patient Dilation Form

Contact Lens Agreement Form

Used for both previous and new contact lens wearers only

Previous Patient Dilation Form