Download the necessary form(s), print it out and fill in the required information. Please fax us your printed and completed form(s) or bring it with you to your appointment.
Online Welcome Form (REQUIRED) - Submit Online*
Visual Needs Assessment Form (Optional) - Submit Online
Infant Vision History (Optional) - Download & Print
Contact Lens Handling (Optional) - Download & Print
Dry Eye Questionnaire (Optional) - Download & Print
HIPPA (Optional) - Download & Print
*Please note that in order to protect your medical privacy, you will be directed to another website. Thank you!
Notice of Nondiscrimination - Section 1557-Affordable Care Act(ACA)
Belleview Eye Associates complies with Federal civil rights laws and does not discriminate on the basis of race, color, national orgin, age, disability or sex.