What is in the form
Your medical history
Medical conditions, the medications you take, allergies, contact lens wear, any past eye surgery, and eye disease in your family.
Your information and insurance
Your contact details, an emergency contact, and your primary and secondary insurance.
Privacy notice and financial policy
Our summary Notice of Privacy Practices and our financial policy, each for you to read and sign.
Before your visit
- Print the form and fill it in at home.
- Bring it with you, along with your current insurance cards.
- If you would rather fill it in here, we recommend arriving about ten minutes early.