1.800.EYECARE

Schedule An Appointment

1.800.EYECARE

Medical & Patient Forms

To expedite your visit, please bring in a completed copy of our medical and patient forms to your scheduled appointment.

English Forms:

pdf-icon Patient Information Form
pdf-icon Medical History Form
pdf-icon Patient Contact and PHI Information Form
pdf-icon Well Vision Form

En Español:

pdf-icon Información Para Pacientes
pdf-icon Historia Clinica
pdf-icon Información Para Pacientes Insurance y Contacto
pdf-icon Información Para el Examen de los Ojos Saludables

What our customers are saying:

My experience at Nationwide was very good. The staff is very nice and made me feel very comfortable with the whole process. They explained everything very well and answered all my questions. I will definitely recommend them to anyone that needs LASIK.

- Liliana A

I would recommend Nationwide to all my friends and family! The staff was extremely helpful. Lynn helped me pick out frames and explained everything in detail.

- Kathie D.

The lady that helped pick out my frames had a genuinely friendly, helpful, and warm personality!  She is a true asset to your business.

- Rosalyn R.