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 am very pleased. I love my new glasses and the way they look!!

- Ashley I.

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 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.