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 was very pleased with the whole process. Everyone was very professional. I received a very nice discount as well. I would recommend Nationwide to anyone i know.

- Keith F

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.

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.