This page has the forms you need to fill out before your appointment, as well as information on an optional procedure that allows us to track the ongoing health of your eyes. Take some time before your appointment to view the Eye Health Screening Photos video. Please print and fill out the correct forms to bring in with you.
New Patient Forms
If you are a new patient, or have not had an exam in 3 years, please complete these forms before your appointment. This will speed up the check-in and appointment process.
Please remember your confirmation number given to you with the online registration.
Returning Patient Forms
Records Release Form (needed if requesting records) Your medical records are considered Protected Health Information (PHI). So, if you need us to release your records to you or another doctor, please complete this form. Download Records Release Form
Risk Assessment Form: Age Related Macular Degeneration (AMD) (optional) This will help us determine your risk level for AMD. AMD is the leading cause of vision loss in adults, currently affecting more than 15 million Americans. Its effects may be permanent and irreversible however you can reduce your risk. Download AMD Risk Assessment Form
Eye Health Screening Photos Form (optional) This optional procedure takes High Definition Photos of your Retina (the back of your eye). These images are very helpful in determining internal eye disease and also helps to monitor changes in the future. Please see the video below and download the form if you are interested in taking advantage of this procedure at your next visit. Download Eye Health Screening Photos Form