Patient Forms

New Patients

Please fill out and return forms 1 and 2  (To fill out as writable PDF–Download form then open and fill out)

If you plan to be fit with contact lenses, please also include form 3

Form 4 is for your information only

Form 5 allows you to have prior records released to our office, if desired

 

1. New Patient’s Information
2. Acknowledgement of Privacy Practices and Authorization to  Bill Insurance
3. Information for Contact Lens Wearers
4. HIPPA Privacy Practices
5. Release of Medical Records Forms