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New Patient Forms

For your convenience, we have uploaded several documents you will need for your first appointment with us. You may download them, fill them out, and bring them in for expedited check-in!

 

Online Form *NEW!*

If you would like to fill out your intake form online, please click here: Adult Patient Online Intake Form.
Otherwise, you may print out and bring in the forms via the links below:

Basic Forms

First is our 2019 Privacy Policy (HIPAA), followed by our Welcome to Our Office Disclosures. The first document informs you that we will not release your confidential medical information without your consent, and in the Office Disclosures document, you give your consent for us to contact you and bill your insurance, and then you also agree to pay any applicable co-pays that may exist at the end of your visit.

The other documents we have for you are the Adult Patient Intake Form (18+) and our Child Patient Intake Form (17-), for whichever applies to your visit.

Special Forms

If the reason for an eye exam is any of the following: problems reading, headaches or eye strain while reading, problems in school or with homework, please fill out and bring in the following, in addition to the above paperwork: Convergence Insufficiency Symptom Survey

If you experience any itching, burning, watering, or other discomfort or awareness of your eyes, please fill this form out, in addition to the above paperwork, and bring it in to your exam: OSDI Dry Eye Questionnaire

We thank you in advance for taking the opportunity to complete these forms before your appointment. We look forward to seeing you soon!