Forms for New Patients

New patients can save time during their first appointment by completing the Patient Registration form prior to their visit. Simply print out the Patient Registration form, fill in the information requested, and bring the completed form with you to your appointment.

Medicare, Healthspring, Medicaid, Blue Cross Blue Shield, along with many other medical insurance plans will not cover the charge for a refraction (a test determining your actual vision perception).  If this test is performed during your exam today, a payment of $45.00 will be expected at the end of your visit.

Please download, review and sign the form below, bringing it into the office on your first visit.

The form below is a survey with statements about problems which involve your vision or feelings that you have about your vision condition. After each question please choose the response that best describes your situation. In order for this survey to improve our knowledge about vision problems and how they affect your quality of life, your answers must be as accurate as possible. Please answer all the questions as if you were wearing your glasses or contact lenses (if any).