Optix Eye Care

Optix Eye Care • Personalized Care • Accurate Vision Prescription • Treatment of Eye Diseases • Contact Fittings

 
 

eye glasses Patient Forms

Get a head start on your eye care appointment. If you are a new patient or need to change your patient information, please download these forms and bring to your next eye care appointment

NEED TO SCHEDULE AN APPOINTMENT? Contact Us.

Save Time! Bring completed forms with you to your next scheduled appointment.

 

New Patient Forms

All-In-One New Patient Forms - (NEW PATIENTS) 
Everything you'll need for your first scheduled appointment 
at Optix Eye Care Center.  6 pages.

 

Existing Patient Forms

 

Lifestyle Questionnaire - (EXISTING PATIENTS)
Fill this out once a year so we don't miss anything important 
for your insurance or Best Eye Health. 2 pages.
 

Basic Patient Information Form - (EXISTING PATIENTS) 
Patient information, Insurance, Questionnaire about your eyes
and your Eye Health history. 1 page.
 

General Health Information Form -  (EXISTING PATIENTS) 
Information about your physical health the Optometrist will need. 1 page.
 

Consent and Disclosure Form - (EXISTING PATIENTS) 
Information about the privacy of your health information. 2 pages.
 

Notice of Payment Policy Form - (EXISTING PATIENTS) 
Information about Optix Eye Care's payment policy. 2 pages.