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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

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

Privacy Practices

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