Our Patient Forms

New Patients to Our Practice


For your initial appointment, we ask you to please bring your driver’s license (or picture ID), any insurance cards that you would like us to use for billing this date of service, a list of medications including current eye drops (over-the-counter and prescription), a list of previous surgeries, any known food or drug allergies, a referral from your primary care physician if your insurance has this requirement, and any additional information that you would like to provide to our office.

Patient Forms

The first visit to our office is designed to get you better acquainted with all that we offer, as well as introduce you to the doctor and our caring staff. We encourage questions and do our best to always deliver quality care. Please take a moment, prior to your scheduled appointment, to download and print our patient forms. We ask that you complete these forms and bring them with you to your appointment, so we may assist you in a timely manner. Thank you for your confidence in our office, we look forward to assisting you with all your eye care needs.

Patient Demographic Form

Refraction Form

Notice of Privacy Practices (English)

Notice of Privacy Practices (Spanish)

Notice of Privacy Practices Signature Page

The above forms require Adobe Acrobat Reader to view and print. If you do not have Adobe Acrobat Reader, click click here to download it.