Please print form, complete and bring to your next office visit.

• Eye Health History Form
• Sensory History Form
• Predictive Checklist for Functional Vision Assessment
• Financial Policy Form
• HIPPA-Notice of Privacy Practices Form

• Release of records
• Progress Evaluation - Children
• Progress Evaluation - Adults
• OD Vision Therapy Referral

Note: Some of these forms are viewed through Adobe Acrobat Reader.