Patient Centre For Existing Patients

Patient Centre For Existing Patients

FOR YOUR VISIT TO INSIGHT OPTOMETRY VISION THERAPY

INTAKE FORM EXISTING PATIENTS

In an effort to make you more comfortable when you arrive at our office and to streamline the new patient process, you will be able to complete all the necessary items prior to your first visit.

Please fill out our pre-examination form below so we are ready for your first visit.

"*" indicates required fields

Full Name*
Preferred Name:
May we contact you by email or text regarding information about appointment reminders, order updates, current sales and promotions?*
Are you planning on using extended benefits for any portion of your visit?*
Policy Details
Max. file size: 128 MB.
Reason for eye exam:*

Do you wear:*
Current glasses:*

Contact lenses:*

This field is for validation purposes and should be left unchanged.

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