Patient center New Patients

FOR YOUR VISIT TO INSIGHT OPTOMETRY VISION THERAPY

INTAKE FORM NEW 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.

  • Date Format: MM slash DD slash YYYY
  • Policy Details
  • Your Medical History

  • Family Medical History

  • 1. Questions about EYE DISCOMFORT:

  • 2. Questions about EYE DRYNESS:

  • 3. Questions about WATERY EYES:

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