Online Forms

At Eldred Eye Center, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReaderĀ® to download and complete the forms.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

Patient Forms

Please bring with you to your appointment.

-Insurance card(s)- have available at every visit

* There are many changes to insurances over the last few years. Please bring your most recent medical and vision insurance.

- Verify your benefits with your insurance company. Let us know if you are here for routine or medical exam.

- Contact lens prescription and evaluation information

*contact lenses are a medical and need to be evaluated every year; In order to keep your contact lens prescription current. Just as you have grown, aged, and changed since your last appointment your eyes have too! There will be a fee for your Contact Lens Evaluation.

* If you are new to our practice please bring your most recent contact lens prescription or boxes.

*glasses old and new

- Health history, we need to know if you have had any surgeries, on any medications, over-the-counter medications, supplements and/or herbs/vitamins, and family history.

Please fill out the forms below before your appointment or show up 15 minutes before your appointment.

Health History

Download & Print Form

Patient Information

Download & Print Form

Release of Records

Download & Print Form


Download the Free AdobeReaderĀ®

Contact Us

We look forward to hearing from you.

Location

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Office Hours

Our Regular Schedule

Monday:

8:00 am-5:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-5:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

8:00 am-1:00 pm

Saturday:

Closed

Sunday:

Closed