Please date and sign, then bring to your first appointment. You may also keep a copy for your records.
Basic information for our records.
Page 1. Please fill in the name and date, then skip down to the medical history questions. Please also remember to fill out 'Medical History, page 2'
Please read over then sign and date ONLY if you plan on/already wear contact lenses. Insurance companies require this form to be kept on file in your chart. See our "Common Questions" section for additional information.