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:

Ms. Yurashak’s took great care of patience in assisting me in selecting a frame that would be the best for my situation. She is warm and caring person who really does go the extra mile to help people.

- Cecilia P

Kurt V. is a great manager. He’s personable, knowledgeable and helpful. I had a defect in my new glasses and he replaced them no questions asked. What great service!

- Barbara B.

My overall experience was excellent. I liked how I could have my pre-ops in Tucson, since there is only one Surgery Center. Joe in Tucson was wonderful. He called me back promptly and alleviated my concerns about the surgery. Overall, a great experience.

- Christopher E