Please print this page, complete, and bring with you to the office for your examination.
Kindly bring your medical insurance card and any vision care coverage information that you may have.
Many ocular exams are covered by your medical insurance if any medical diagnosis conditions are detected at the time of the exam.

Items to bring to appointment on date of examination include:
(1)Insurance card(s)
(2)Eyeglasses
(3)Contact lens information/boxes
(4)List of medications
(5)Completed medical history form (available below)