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:

I had a quick and easy transition from the eye doctor to the Nationwide Laser Center. I had my eyes examined and asked if there was anything I could do to help the headaches I was getting from my glasses. Dr. Ruda gave me a phone number for LASIK. I called to set up an appointment, and the rest is history. The staff is very professional, courteous, and friendly. I wish I had this done 20 years ago. Thanks to the whole staff for blessing me with great vision and NO glasses, that were causing headaches and even migraines.

- Wayne J

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.

Everyone at Nationwide was very helpful. I am very grateful for the time you took to help us find the right pair of glasses for me.

- Pat S.