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.

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Medication List

Medication Form

This form should be completed by all new patients, and by established patients coming for annual comprehensive examinations.

Medical History

Medical History Form
This form should be completed by all new patients, and by established patients coming for annual comprehensive examinations.

Cataract and Refractive Surgery Index

Cataract and 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:

Amsler Grid

Use this form to help monitor your vision if you have macular degeneration, or other macular disorders.

Glaucoma Medication Information sheet

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)

Ocular Surface Disease Index (OSDI) Form

Use this form to help your doctor determine the severity of your dry eye symptoms and plan proper treatment.

SmartSight- Vision Rehabilitation Information

SmartSight- Vision Rehabilitation Information

Information from the American Academy of Ophthalmology regarding how to manage life with various degrees of vision loss.  Includes links to numerous resources.

Please assist us with our efforts to protect your identity and your health information. Please bring your driver’s license or other photo identification as well as your current insurance card to your appointment. This information will be placed into your electronic medical record. We appreciate your assistance