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Existing Patient Form

  • Reason for Your Visit Today

  • Recommended Screening Tests

  • This central & peripheral vision test is extremely powerful in screening for early signs of eye disease. It is extremely useful in patients suffering from headaches, suspected vision loss, diabetes, hypertension. Studies have shown this test to be the most accurate early screener for glaucoma and forms of blindness. To date, our doctors have saved the lives of several patients by diagnosing tumors that presented with no symptoms using this test. Recommended annually on ALL patients over the age of 18.
  • This newly approved test allows doctors to detect signs of macular degeneration before we the visible signs are detected in a normal eye exam. If you suffer from night glare, or dark adaptation issues, this test is useful in ruling out disease.
  • (instead of $50)
  • No Show or Missed Appointment Agreement

    Our office observes a strict no show, missed appointment policy. Failure to arrive within 15 minutes of a scheduled appointment will result in a ‘missed appointment’ and you may need to reschedule to another time. We understand that there will be times where a scheduled appointment cannot be kept. If you need to cancel or reschedule an appointment, we request that you notify our office at least 24 hours in advance. If you do not notify us with 24 hour notice, or do not show for your appointment, we will consider this in violation of our agreement. You will be assessed and billed a fee of $35 for the missed appointment.

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