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Distinction in Eyewear and Eyecare

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New Patient Forms

To fill out the New Patient Intake Form online, click here.
To fill out the HIPAA Information and Consent Form online, click here.

Printable PDF versions of our office forms are below:

New Patient Intake Form
New Patient Registration Form
HIPAA Information and Consent
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Please note our adjusted hours for the end of this week: Thursday, May 26, 8:30 am to 4:30 pm, and Friday, May 27, 8:00 am to 2:00 pm. We will be closed on Monday, May 30 in observance of Memorial Day. Thank you!