Patient Forms

 

The following forms are in PDF Format:

Adult Forms (PDF):

Refraction waiver

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Contact Lens Service Fee Agreement

 

Pediatric Forms:

Pediatric Refraction Waiver

Pediatric Health History Form


Miscellaneous Forms:

Minor Child Medical/Surgical Treatment Authorization Form

Protected Health Information Authorization Form

Authorization to Obtain and/or Release Records

 

Privacy Practices

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Privacy Practices