Pediatric Medical History Form for new patients – PDF
After reading the HIPAA privacy statement we ask that you print this acknowledgment out and sign it. When you arrive for your initial appointment, please bring a signed copy to the office . By law, we must keep it on file as a part of your medical record.
HIPAA Privacy Acknowledgment – PDF
This form would be used if you would like us to transfer your records to another doctors office.
Medical Records Release Form – PDF
Download this PDF to view the full warranty information we give out with every pair of glasses we sell.