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Hartland Eye Care

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11200 Highland Rd, Hartland, MI 48353 –

810-632-5240


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.

HIPAA Authorization Form – Download & Print | Submit Online

New Patient Adult Form – Download & Print | Submit Online
Required for All Patients Over 18 Years of Age

New Patient Youth Functional History Form –  Download & Print | Submit Online
Required for All Patients From 5-18 Years of Age

TBI (Traumatic Brain Injury) History Form – Download & Print | Submit Online

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

SPEED Dry Eye Questionnaire – Download & PrintSubmit Online

Hartland Eye Care
Carrie D.Carrie D.

Dr. Doud and his employees are very Professional. Dr Doud goes above and beyond a normal Eye exam. Very Trustworthy. Read More

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