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Patient Forms

The forms included in this registration packet enable us to learn about your health and how it affects your vision, understand your overall health, track the effectiveness of your treatment, and accurately bill your insurance.

We realize filling out paperwork for healthcare in today’s world is time consuming. We have made every effort to minimize the paperwork required for our patients, while also getting the information we need to provide you with the highest quality service possible.

The following forms are included:

#1 – Patient Registration

All new patients must complete this form. Existing patients may need to update information. Please bring your insurance card(s) to your first visit, as we will need photocopies for our records.

Download Patient Registration Form

#2 – Patient Initial Questionnaire and Medical History Form

Your answers on this form will allow us to have an accurate picture of your current physical condition and is valuable for a thorough evaluation by your doctor.

Download Patient Medical History Form

#3 – Patient Visual Function Form

Completion of this form will give us a better understanding of your current visual acuity.

Download Patient Visual Function Form

#4 – Medical Records Form

Completion of this form will allow us to release your medical records.

Download Medical Records Form (English)
Download Medical Records Form (Spanish)

#5 – Parental Consent Form

Completion of this form will allows a parent, custodian, or guardian to authorize diagnosis, treatment, or care for a minor.

Download Parental Consent Form

#6 – Maintenance and Return Policy

Maintenance, warranty, and return policy for eyeglass frames and lenses.

Download Maintenance and Return Policy

More Information

Please contact the clinic where you have scheduled your appointment directly if you have questions. As a reminder, be sure to bring your insurance card and any co-payment that you may be required to make to the visit. We accept cash, personal checks, and bankcards and can arrange for financing.