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Patient Forms

Family Vision Centers Patient Forms

Printable / Downloadable PDF Documents

Patient Information Form
The patient information form is required by Family Vision Centers for all new patients.

Hippa Privacy Form
This notice describes how protected health information about you may be used and disclosed and how you can get access to this information.

Authorization For Release
This form must be filled out to allow family members such as their spouse, parents or others to call and request medical or billing information.

Spanish Patient Information Form
The patient information form is required by Family Vision Centers for all new patients.

CareCredit Application
Set your sights on living a full and active life with LASIK & vision care financing through CareCredit.

Sign-up using the form or call us to make an appointment

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