The forms below may be opened in .pdf format and filled out prior to your visit. Please bring them with you, along with your insurance cards and any existing eyeglasses or contact lenses you are using.
Click on the forms below to download in .pdf format and print.

Welcome Form

This is a 1-page form that helps us know how to contact you, where to bill your insurance and for you to acknowledge that you have recieved or read a copy of our privacy practices.

Health History Form

This is a 1-page form that helps us get to know more about your health and the history of your eye's health.

Privacy Practices

This is a 2-page informational handout that informs you, the patient, how we may use and disclose your information. It defines your rights under the Health Insurance Portability & Accountability Act (HIPAA). Please review this before signing your welcome form.

Below are other useful forms for all patients:

Missouri Eye Examination Form For School
Form MO 580-2916 (10-09)

Beginning July 1, 2008, every child enrolling in kindergarten or first grade in a public elementary school in this state shall receive one comprehensive vision examination performed by a state licensed optometrist or physician.