Online Forms

At the Center for Eye Care and Optical, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReaderĀ® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

New Patient Registration

Download & Print Form

Existing Patient Update Form

Download & Print Form


Financial Agreement & Refraction Fee Information

Download & Print Form


Privacy Policy

Download & Print Form


Medical Record Release

Download & Print Form



HIPPA Guidelines

The notice of privacy describes how medical information about you may be used, disclosed, and how you can get access to this information. Please review it carefully. If you have any questions about this notice, please contact our Privacy Officer.

Download & Print Form


Download the Free AdobeReaderĀ®

REQUEST AN APPOINTMENT

Please fill out the form below and a representative will contact you within 48 hours.

Hours of Operation

Monday

9:00 AM - 7:00 PM

Tuesday

8:00 am - 7:00 pm

Wednesday

8:00 am - 7:00 PM

Thursday

9:00 am - 7:00 pm

Friday

8:00 AM - 5:00 PM

Saturday

8:00 am - 3:00 pm

Sunday

Closed

Monday
9:00 AM - 7:00 PM
Tuesday
8:00 am - 7:00 pm
Wednesday
8:00 am - 7:00 PM
Thursday
9:00 am - 7:00 pm
Friday
8:00 AM - 5:00 PM
Saturday
8:00 am - 3:00 pm
Sunday
Closed

Location

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