Patient Access

Patient Forms

For your convenience, Family Vision Care Associates offers the following forms to be downloaded at your convenience prior to your visit to our offices:

New Patient Medical History for Adults / Students

*ALL NEW PATIENTS, please print and complete one of the two Medical History Forms listed below and bring it with you to your appointment.

Print / Complete / Sign - ADULT Medical History Form

Print / Complete / Sign - STUDENT Medical History Form

Other Forms

If you wish to give authorization to someone so that we may discuss your health record and billing pertaining to our office with them, please:

Print / Complete / Sign - HIPAA PRIVACY AUTHORIZATION

If you wish to give us authorization to release your medical record to another doctor or entity, please:

Print / Complete / Sign - RECORD RELEASE

If you wish to give us authorization to exam/treat your minor child without a parent being present, please:

Print / Complete / Sign – PARENTAL CONSENT FOR MINOR

InfantSEE Program

If you wish to take advantage of a comprehensive vision exam for your infant (The InfantSEE Program), please use the forms (English or Spanish) listed below:

Print / Fill Out InfantSEE Form - English