We use these forms to gather some basic information about you for the purposes of contacting you, verifying your insurance coverage, obtaining authorization to provide services, and billing the services provided to your insurance company. The second page of the form contains information about our office financial and privacy policies. For each person scheduled for a visit at our office, please print these forms, complete them, and bring them with you when you come to our office for your examination. By completing these forms in advance, you will save a significant amount of time during your visit to our office.

This form allows us to get some information about your previous and current eye health and vision conditions. It also gives us some information about your general health and any medications that you are taking, helping us to detect any eye condtions that may be occurring due to your health conditions or medications. Once again, for each person scheduled for a visit at our office, please print this form (both sides), complete it, and bring it with you when you come to our office for your examination. By completing this form in advance, you will save a significant amount of time during your visit to our office.