Patient Forms

New Patient Information Form 

If you are an adult first time patient and would like to save time when you visit, click the link below to fill out your New Patient Information Form online.

• Adult (Because we have two locations, please be sure to choose the button for the location where your exam is scheduled at the end of the form.)

For an Infant/Toddler or Child first time patient, please click on the appropriate link below to complete the form. Then, print it out and bring it to their appointment.

• Infants/Toddler (Under 5 years of Age)
• Child (5 to 18 Years of Age)

Functional Vision Evaluations

In addition to Eye Health Exams, we offer specialized testing for patients with computer eye fatigue, eyestrain, lazy eye/eye turns and adults and children with reading or learning issues related to ADD/ADHD, Dyslexia and other conditions. Click on Vision Therapy tab to learn more.

(Please note that the following forms are for specialized testing at our Rosedale location. Call (512) 371-0144 to schedule an exam before completing any of these forms.) 

Functional Vision Evaluation Questionnaires

• Adult
• Child
• Young Adult

Functional Vision Evaluation Fees

• Child or Young Adult
• Adult

Patient Privacy

We are committed to the protection of your personal information. Please click on this link to View our privacy practices.