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Menu
  • Our Team
  • Locations
  • Contact
  • Optical
  • Patient Info
    • Forms
    • Insurance & Billing
    • Patient Services
    • Conditions We Treat
    • FAQ
  • Research
  • Tour
  • Careers
  • Blog

Forms

Forms

New Patient

New patients can save time at their appointment by bringing completed and signed forms with them.

Registration Forms

New Patient Intake - complete prior to scheduling first appointment

Registration - online - complete prior to your visit, after an appointment is scheduled

Child registration form - printable - if you cannot complete online registration

Adult registration form - printable - if you cannot complete online registration

Consent Forms

Consent for Dilating Drops

Consent for Contact Lens Fitting

Additional Fees Disclosure

Authorization to Give Consent for Outpatient Treatment

Notices

Notice of Privacy Practices

Acknowledgment of Receipt of Privacy Practices

Records Request

Medical Records Request - to get records from Virginia Pediatric Eye Center

Medical Records Request - to send records to Virginia Pediatric Eye Center

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