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.

My experience was very good. Dr. Peters and his staff answered all my questions and were willing to “narrate” step by step as the procedure was happening. The procedure and day of surgery went very quickly.

- Kanani C

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