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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

The Eye Care Connection, Inc. is now part of Optometric Associates!
We will be taking care of all patients from The Eye Care Connection, Inc.  at our office, including all specialty contact lens patients.

If you were a previous patient of Dr Gogola, please click here for further information including a letter from Dr. Gogola. 

the eye care connection