Inbound Referrals from Doctors:

  1. Inbound referral form (doctors only)

Save Time!

Download and fill out your forms, then bring the completed forms with you to your appointment.

Forms to complete for your examination:

  1. Personal Information form
  2. Medical History form
  3. Contact Lens Policies form
  4. Advance Beneficiary Notice
  5. Binocular Vision Survey (CISS)

Other forms and surveys:

  1. Record Release form
  2. Photo/media Release form

Patient Resources

  1. OTC (Over-the-counter) resources
  2. Amsler Grid