Patient Forms

Patient Forms

Patient Forms

1. At Eyes on Main, we offer patient forms online so you can complete them in the convenience of your own home or office. Please go to:

Online Form

If a new patient, press "New patient page", complete the form, and press submit data at the end.

If an established patient at Eyes on Main, please enter the passcode emailed to you. If you do not have the passcode, please contact the office so that we can resend it to you.

2. If you are a new patient to the office, please complete the Medical Records Transfer Release Form and return it to the office.
Download PDF

3. Please bring the following to your appointment:

  • Your current glasses and contact lens information

  • Form of ID

  • Most recent medical insurance card

  • Medicine list

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