Patient Forms

PDF Forms

(to be printed, filled out, and brought to your appointment)

Thank you for choosing The Eye Care & Surgery Center to be your eye care provider. The doctors and staff hope to reward your faith in our practice by exceeding your expectations.

Please complete these forms and bring them with you to your appointment at our office. Also, please remember to obtain any necessary referrals, if required by your insurer. If you have current glasses, please bring them with you. If you wear contact lenses and are not having a problem, it is helpful to wear the lenses for your appointment.

The staff of The Eye Care & Surgery Center is dedicated to making your visit to our office a pleasant experience. We appreciate any comments you may have that will allow us to improve our service to our patients and their families. Please feel free to share your observations with any staff member or ask to speak with the Practice Administrator.

Sincerely,
The Doctors and Staff of The Eye Care & Surgery Center

New Patient Registration
English (PDF)
Spanish (PDF)

Returning Patient Registration
Returning Patient Form (English)
Returning Patient Form (Spanish)

Other Forms
Cataract Patient Lifestyle Vision Questionnaire
Refractive Health History Form

CLICK HERE for
Patient Forms

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