Patient Forms

 

The following forms are in Adobe Acrobat PDF Format. If you do not currently have Adobe Acrobat software, it is available for download at no cost on the Internet. Download Acrobat Reader 


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