Your Full Name (first & last):


Appointment Date:

Appointment Time:

Any Additional Comments:


 

Note: Please check your mail client to ensure that your email was delivered.

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

How should you prepare for your exam?

You can save time by printing, reviewing, and filling out check-in paperwork ahead of time. Please remember to bring the completed forms to your exam.

All patients should bring:

  1. New Patients 18 years & older: current photo ID
  2. List of current prescription medications that you are taking
  3. All recent glasses (includes all glasses that you actively use such as reading, computer, or sports glasses)
  4. Sunglasses

Contact lens patients should bring:

  1. Copy of your previous contact lens prescription or old boxes/labels/vials that show specifications
  2. Wear your contacts to the appointment, unless you are having problems. Do NOT wear contacts if you are having problems -- instead, bring that pair in your contact lens case.
  3. Note which contact lens solutions & drops you are using.
  4. All recent glasses (includes all glasses that you actively use)
  5. Sunglasses