From this page you can download a number of forms used in our practice. Completing them ahead of your appointment will save time on the day of your visit. Forms are saved in Adobe Acrobat PDF format and can be viewed and printed with the free Adobe Reader program. If you do not have this installed on your computer, click here or on the “get Adobe Reader” link below to download and install the program. A new window will open to the Adobe web site. Close it to return here when installation is complete.
Medication List: This form should be completed by all new patients, and by established patients coming for annual comprehensive examinations.
Medical History: This form should be completed by all new patients, and by established patients coming for annual comprehensive examinations.
Cataract & Refractive Surgery Index: Please complete this form if you are considering either cataract surgery, or refractive surgery such as LASIK or clear lens replacement.
Amsler Grid: Use this form to help monitor your vision if you have macular degeneration, or other macular disorders.
Glaucoma Medication Information sheet: Information for patients taking glaucoma medications, including tips for taking eye drops and side effects of commonly prescribed glaucoma medicines.
Ocular Surface Disease Index (OSDI): Use this form to help your doctor determine the severity of your dry eye symptoms and plan proper treatment.
Please assist us with our efforts to protect your identity and your health information. To comply with new Federal Red Flag regulations we are requesting your driver’s license or other photo identification at the time of your appointment. We are also asking for your current insurance card. If your photo ID does not show your current address, please bring a utility bill or other correspondence showing your current address. This information will be placed into your electronic medical record. We appreciate your assistance.