Patient Forms
New Patient
Paperwork.
Please review and complete the forms below before your first visit. You can print them at home or fill them out at our clinic.
Medical Information Form
Patient medical history and current health status
HIPAA Notice of Privacy Practices
Privacy policy and patient rights acknowledgment
Financial Disclosure & Insurance Information
Insurance coverage and payment responsibility
Insurance & Refraction Policy
Vision vs medical insurance and refraction testing policy
Contact Lens Fitting Agreement
Contact lens evaluation and fitting policy
No Show Agreement
Appointment cancellation and no-show policy
Parental / Guardian Consent
Consent form for minors with parental authorization
Pro Tip: Print or download all forms before your appointment to save time at check-in. If you have any questions about these forms, please call us at (309) 788-5524.