Due to COVID-19 our office is open by appointment only. In an effort to keep patients and staff healthy, we are still requiring all patients to wear a mask while in the office. Thank you for your understanding and cooperation.

Adult Patient History

Ocular History

Was your last eye exam at our office?

If no, who did you last see and when?

Do you see an Ophthalmologist (specialist)?

If yes, who do you see?

Do you wear glasses?

If Yes:

Do you wear contact lenses?

Do you wear sunglasses?

Does your job/hobby require safety glasses?

Visual Concerns and History

Please check all that apply

Medical History

Please check all that apply

Please list your medications or supplements below or bring a list:

Our Office Hours


8:30am - 12:00pm
1:00pm - 5:00pm


8:30am - 12:00pm
1:00pm - 5:00pm


8:30am - 12:00pm
1:00pm - 5:00pm


10:00am - 2:00pm
3:00pm - 7:00pm


8:30am - 12:00pm
1:00pm - 5:00pm

Closed Saturday, Sunday and Stat Holidays