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Niagara Falls: 716-282-1114 Directions
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Documents

Pediatric Medical History Form for new patients – PDF

After reading the HIPPA privacy statement we ask that you print this acknowlegment out and sign it. When you arrive for your inital appointment please bring a signed copy to the office . By law, we must keep it on file as a part of your medical record.

HIPPA Privacy Acknowlegment – PDF

This is our privacy policy. Please review it before your first appointment.

HIPPA privacy policy – 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 fiull warranty information we give out with every pair of glasses we sell.

Optical Warranty Information – PDF

Please fill this form out and bring it to your first appointment.