If you have an appointment scheduled and want to come prepared, just print this form out, fill in what you can, and bring it with you to your appointment.

Please do not fill in or write in any part of the form that is labeled "Office Use Only".

If you have any questions about any part of the form, please feel free to call us!

There is a spot on the bottom of the form that is labeled "Office Use Only" for the Optomap. In case you do not know what the optomap is you can click on the page labeled "Optomap" and it will give an explanation of what this machine does. At the time of your appointment you will be asked if you would like to do this machine and at that time you can ask any questions you may have.

We look forward to seeing you!