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 from my very first phone call to schedule my consultation until now, has been wonderful. Everyone that I have talked to and worked with has been great and very helpful. I would definitely recommend Nationwide Vision to anyone.

- Rebeca H.

I had no idea you had such a selection of great eyewear. The optometrist helped me find the pair that fit my face, my personality and highlighted my eyes – which, I’ve been told, are one of my best features!

- Mel P.

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