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:

The Nationwide staff was very efficient. Demetre in particular was very kind and explained to us about the style and choice of eyewear for my daughter. Thank you!

- Tina W.

My experience went exceptionally well from the first visit and phone call. I would definitely recommend Nationwide to a friend or family member.

- Juventino F

The staff were so friendly and funny. They made my glasses experience effortless and were especially helpful in picking the right look for my face. Thank you!

- Kaileena M.