New Patient Information Form

NOTE: This form will not schedule an appointment. If you need to schedule an appointment, please follow this link to fill out the Appointment Scheduling Form.

Your time is valuable, and it’s important to us that we don’t waste it. One way we achieve that is by being prepared for your appointment and ready to help you with your unique needs. If you are a new patient, please fill out the form below to provide us with your information. Thank you!

New Patient Information Form

  • Patient Information

    The asterisks (*) indicate mandatory fields.


  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Medical History

  • Primary Insurance

  • Note: Please still bring all insurance cards with you to your appointment!


  • MM slash DD slash YYYY
  • Privacy Policy

Book Your Appointment Today!

Whether you are looking for a comprehensive eye exam, new glasses or contacts, or more, our experienced optometrists and opticians are ready to serve you!