After instruction from our staff, please print and complete the appropriate forms, and bring them with you to your appointment.

• New Patient Exam Forms
  
  • Child Exam
  • Adult Exam
    
  If eye turn present:
  
  • Child with Eye Turn
  • Adult with Eye Turn
    
  
  New Patient Consultation Forms
  
  • Child Consult
  • Adult Consult
  • Vision Rehabilitation
    (acquired brain injury, stroke, motor vehicle accident)
    
  If eye turn present:
  
  • Child Consult with Eye Turn
  • Adult Consult with Eye Turn
    
  
  Returning Patient Forms
  
  • Child Returning Patient
  • Adult Returning Patient
    
    
  Other Forms
  
  • Consultation Referral Form for Optometrists
  • Quality of Life Symptom Checklist for Progress Evaluations
  • HIPPA - Notice of Privacy Practices Form
  • Release of Records
  • Financial Policy

Note: All forms are viewed through Acrobat Reader.