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Menu
  • Our Team
  • Locations
  • Contact
  • Optical
  • Patient Info
    • Forms
    • Insurance & Billing
    • Patient Services
    • Conditions We Treat
    • FAQ
  • Research
  • Tour
  • Careers
  • Blog

Forms

Forms

New Patient

New patients can save time at their appointment by bringing completed and signed forms with them.

Registration Forms

Registration - online

Child registration form - printable

Adult registration form - printable

Consent Forms

Consent for Dilating Drops

Consent for Contact Lens Fitting

Additional Fees Disclosure

Authorization to Give Consent for Outpatient Treatment

Notices

Notice of Privacy Practices

Acknowledgment of Receipt of Privacy Practices

Records Request

Medical Records Request - to get records from Virginia Pediatric Eye Center

Medical Records Request - to send records to Virginia Pediatric Eye Center

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