Patient Forms

Please take the time to fill out the online registration before you visit us so that we can make your appointment with us more enjoyable, efficient, and personalized for your specific vision needs!

COMPLETE ONLINE REGISTRATION

SUPPLEMENTAL FORMS

CHILDREN/STUDENT

Developmental/Sensory Form

CONCUSSION/BRAIN INJURY

TBI Supplementary History Form
TBI Symptoms Checklist
TBI & Stroke – Release Form

VISION THERAPY

Vision Therapy Progress Evaluation Questionnaire – CHILD
Vision Therapy Progress Evaluation Questionnaire – ADULT

PATIENT INFORMATION

Authorization & Release of Medical Records
Financial Policy and HIPAA Privacy Practices

GET IN TOUCH

To learn more, please fill out the form below and one of our Patient Care Coordinators will be in touch to answer your questions and/or help schedule an evaluation for you.