Find the right form(s) for you

LipiView Dry Eye Questionnaire Click to download

Present this form if you are experiencing dry eyes or will be having a dry eye evaluation.

Extended Adult Health Form Click to download

Please fill out this form if you are seeking vision therapy services for an adult patient and bring it with you to your appointment.

Extended Child Health Form Click to download

Please fill out this form if you are seeking vision therapy services for a pediatric patient and bring it with you to your appointment.

HIPAA Form Click to download

Here is a copy of our privacy practices.

Preschool Vision Form Click to download

Present this form if your child is 3, 4, or 5 years of age and will be having an eye examination. Please fill out the form completely.

Youth Vision Form Click to download

Present this form if your child is between the ages of 6 and 18 years of age and will be having an eye examination. Please fill out the form completely.

Employment Application Form Click to download

If you are applying for a job with EyeCare Specialties please fill out this form completely.

Save Your Data