Eldred Eye Center
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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
File Size: 267 kb
File Type: pdf
Download File

Patient Information
File Size: 357 kb
File Type: pdf
Download File

Release of Records
File Size: 364 kb
File Type: pdf
Download File

Contact Us
Eldred Eye Center Of Cheyenne
2029 Bluegrass Circle, Suite 100
Cheyenne, WY 82009
Phone: 307-638-2020
Office Hours
Mon    8:00 am - 5:00 pm
Tue     8:00 am - 5:00 pm
Wed    8:00 am - 5:00 pm
Thu     8:00 am - 5:00 pm
Fri       8:00 am - 1:00 pm
Notice of Privacy Practices

  • Home
  • Location
  • Our Practice
    • Reviews
  • Our Services
    • Children's Exams
    • Other services
  • Order Contact lenses
    • About our contact lenses
  • Our Optical
    • Lens Materials
    • Promotions
  • Patient Forms
  • Glossary