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:

Very happy with surgery. Very little pain. Will be happy to refer my family and friends. Staff at laser center was very friendly and professional.

- Sean H

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.

Very helpful and friendly at first phone call. Day of Exam, staff was wonderful and very patient with all my questions. Surgery day went well. Having the Dr. communicate through the procedure was comforting. I will be referring my co-worker here!

- Kimberly E