Required Forms

Please sign the three forms below. These forms are required for providing services to our patients and customers.

  • Privacy Policy Form (1/3)

    Outline of how the practice collects, stores, uses, and protects your information.

    Sign

  • Terms of Service Form (2/3)

    Summary of policies and terms for providing products and services.

    Sign

  • Prescription Delivery Form (3/3)

    Acknowledgement to receive your prescriptions electronically or on paper.

    Sign

Optional and Other Forms

You only need to sign these forms if directed by a member of our team. These forms are optional and are only required for specific instances.

  • HIPAA Authorization Form

    Permission to share your information with designated individuals or other entities.

    Sign

  • Lens Replacement Damage Waiver

    Acknowledge the risk of damage if frames purchased elsewhere are damaged.

    Sign

  • Record Release Form

    Request the transfer of your records to yourself or to another healthcare provider.

    Sign