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On-line Registration

You can download, and print the forms below, then bring them with you for your exam OR save time and paper by utilizing our online registration system - your information is securely transmitted directly to us, just let us know, when you come in for your appointment, that you have filled out the forms online. (Please note: The web registration has a "click to review" and a "click to submit" process after which, you will receive a registration number. Make note of that number and bring it to your appointment. This will help us to retrieve your information if there are any issues.)

Just click the link below to get started!

Here is a link to a website that can assist you with eyewear and lens decisions based on your lifestyle and optical needs. Feel free to print out the results and bring them in for our opticians, so we can provide you with even more personalized service.

If you don't want to utilize our on-line registration, you can still save some time by printing and filling out the forms below and bringing them with you for your exam.

  • You will need AdobeReader® to download and complete the forms. 
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Please bring the signed and completed forms to your appointment.

Eye Contact Patient Registration and Health History Form 

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

Download & Print Registration Form

Download & Print Health History

Eye Contact Notice of Privacy Practice

Please print and sign this notice and bring it in with your registration form.

Download, Print & Sign Notice of Privacy Practice 

Eye Contact Dry Eye Questionnaire

If you are between the ages of 18 and 60 please complete this questionnaire and bring it with you also.

Dry Eye Questionnaire

InfantSEE Patient History Form