Online Forms

Online Forms

Speed up your visit by completing the necessary form(s) below. For your convenience, you can either fill the form(s) out online or download and print the form(s) and bring it with you to your appointment.

New Patient Adult Form - Download & Print

Required for All Patients Over 18 Years of Age

New Patient Youth Functional History Form - Download & Print

Required for All Patients From 5-18 Years of Age

Advanced Wellness Screening form - Download & Print

There are two tests that can detect glaucoma very early. If you want to be certain that you don't have early glaucoma you can choose to have these tests.

There is another test (Eye Q) that determines the density of macular pigment. This is a great way to determine if you are getting the proper level of nutrition.

TBI (Traumatic Brain Injury) History Form - Download & Print

30 Point Quality of Life Survey - Download & Print

    Should be filled out if the patient has had any history of learning problems such as:

    • ADD/ADHD
    • Dyslexia
    • Special education services
    • Reading delays
    • Excessive time spent with homework
    • Reading ability not consistent with their ability in other areas
    • A learning problem requiring the services of tutors in or outside school