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Drs Hawks Besler Rogers and Stoppel Optometrists provides our forms online so that you can fill them out in the comfort of your own home and at your convenience. You can download the fill-able PDF to complete and bring with you to our hospital.

If you would like to download the PDF, and do not already have AdobeReader® installed on your computer, click HERE to download.

Please note: We kindly ask all patients to fill out the online forms before their appointment. This will speed up the check-in and appointment process. Thank you.

Before your appointment

Before your appointment we kindly ask to fill out some basic information about your health and vision. This helps the doctor during the exam time by understanding more about your general lifestyle and health. Click here to access our Health History form.


We are required to update this form yearly for all patients – both new and returning patients. This gives us permission to conduct your eye exam and allows us to share your information with authorized persons. Click here to access our Consent to Treat form.

  • If you have signed this in the past year you do not need to sign.
  • If you need to change who has access to your records, please update.

Frequently Used 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

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