Patient Forms

Adult New Patient Form

Click here if you prefer to download a copy of this form as a PDF file to print out and fill in by hand.

We want your visit to our office to be as easy as possible for you. Completing this information prior to your visit will help us create your patient record in advance and reduce your time in the waiting room.

You can submit this form electronically by filling in the boxes – simple, secure, quicker than writing legibly, and it’s paper-free — or you can be print the blank form, fill in your information and bring it with you to your appointment.

Complete eye examinations take anywhere from 1 to 2 hours in the office depending on what tests, if any, are required so please plan accordingly. We will almost certainly dilate your eyes and that may make driving more difficult.   So you may want to have someone come with you to drive.

After completing the New Patient Forms either electronically or in writing, including the Notice of Privacy Practices Acknowledgement, please bring with you:

  1. Current insurance cards and I.D.
  2. List of all current medications and pharmacy information.
  3. Any referral forms required.

Please proceed  below with submitting your information electronically, or [click here] to print the forms.

1 PATIENT
2 GUARANTOR
3 EMERGENCY CONTACT
4 SIGNATURE
  • ADULT NEW PATIENT FORM