Patient Forms

Vision Therapy Patients
We kindly ask that you complete the following forms and bring them to your scheduled appointment:

1. 30 Question Symptom Checklist
   
   Vision Symptom Checklist (PDF) OR complete and print our Online Vision Checklist
   
   
2. History Form (Choose one)
   
   Pre-K History Form (PDF)
   
   Student History Form (PDF)
   
   Adult History Form (PDF)
   

Low Vision / Neuro-Optometry Patients
We kindly ask that you complete the age-appropriate form and bring it to your schedule appointment.

• Pre-K History Form (PDF)
  
  
• Student History Form (PDF)
  
  
• Adult History Form (PDF)

Other Forms

• Medical Records Release (PDF)
  
  
• Location Map (PDF)