PATIENT FORMS

Please use the links below to download the listed patient forms

Privacy Policy

Website Privacy Policy

Financial Policy

New Patient Form

Existing Patient Form

Refraction Form

This form explains the refraction policy. By law your prescription for glasses and/or contacts, is only valid for one year. If you choose to update your glasses prescription, you must sign that you agree to the policy.

**CONTACT LENS WEARERS**: You MUST have a refraction to update your contact lens prescription, regardless of your desire to update your glasses prescription.

1. Print and sign the document and return it to us. Clinic location noted on the form or you may email signed forms to frontoffice@lawrenceeyecare.org

2. Clicking “Refraction Form” above will allow you to fill and sign electronically. When you have completed the form simply hit “Finished” at the top and it will notify our front office staff that you have done so.

Authorization to Release

To obtain Authorization to Release your healthcare Information, we require a signature. You can choose from either option below:

1. Print and sign the document and return it to us. Clinic location noted on the form or you may email signed forms to frontoffice@lawrenceeyecare.org

2. Clicking “Authorization to Release” above will allow you to fill and sign electronically. When you have completed the form simply hit “Finished” at the top and it will notify our front office staff that you have done so.