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Our Office Forms

At Modern Optometry, we value your time. In an effort to save you time in our office, you can complete our patient form(s) prior to your appointment.


Patient Medical History Form – Required

Please complete this form as it lets us know the history and current state of your health. Let us know what questions, concerns, and goals your have regarding your eye health or vision on the form.

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Patient Insurance Form – Required

Please complete this form to allow us to process your insurance paperwork more efficiently.

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HIPAA Patient Privacy Compliance Notice

This form shows how your privacy is protected with our office.


If you prefer to download the forms and complete them later, you will need AdobeReader®:

  • Click icon below to download

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  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

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