• Patient Information Form
    Every new patient and returning patients who have had a change in address or phone number must fill this form out at the office or bring in a completed form. Please remember to sign and date the second page.
  • Financial Agreement Form
    Every patient must fill this form out at least once a year.
  • Privacy Acknowledgement Form
    Every new patient must fill this form out. Returning patients only need to complete this form if they have not done so before. Before signing this form, please read our Privacy Practices.
  • Refraction Charge Form
    Patients coming in for a comprehensive exam must fill this form out, unless you are using a vision plan. Bear in mind that prescribing glasses is not a medically necessary procedure, and therefore will not be covered by most major medical insurances when performed during a medical examination.
  • Meaningful Use & Patient Portal
    This form asks additional questions required by new healthcare laws and provides registration information for our online patient portal. Every new or established patient must fill this form out.
  • Medical Questionnaire
    A full medical history is required not only by insurance companies, but also by the doctor, in order to best treat you. We ask that you complete one of these forms if you are a new patient, or are coming in for your regular eye exam.
  • Records Release
    This form only needs to be filled out if you would like to authorize our office to acquire records from another practitioner or if you need us to send your records to other practitioners.