Save Time! Use this form to submit, or print information about yourself or your Family member and speed the insurance and paperwork process.

Don't forget to include Family members - especially children! Early Ocular Health Care for your  children is very important. Many Families do not realize the importance of early care and treatment for children's' eye health.

Please use this form to record, and print your medical history information.  If there are changes to either your, or a Family member's health, please use this form to keep your Doctor informed.

Remember, regular exams, early detection and treatment are the best ways to ensure Ocular Health. The more we know about your medical history, the more effectively we can treat you.