Eye exam appointment forms

For your convenience, we have made our patient eye exam appointment forms available online so that you can fill them out at your leisure.

We understand that your time is valuable! Having your eye exam appointment forms completed prior to your visit will make the check-in process smooth and efficient, and allow you to relax before your scheduled appointment.

Please complete one set of forms for each new or existing patient. Having accurate, up-to-date patient information will allow us to provide you with the best eye care experience possible. Hazel Family Eyecare cares about your privacy and personal information, and reasonable measures have been taken to secure your information. Please contact us if you have any questions.

If you prefer, you may arrive for your appointment a few minutes early and fill out the forms in our office.

Patient Intake Form

Existing Patient Information Form

HIPPA Privacy Policy

Insurance Authorization and Financial Agreement

We accept these insurances:

Vision Insurances: VSP, Eyemed, Superior Vision, Avesis, Spectera, NVA, Tri-Care, Medicaid (Exam only)

Medical insurances: BCBS, United Health Care, Medicare, Aetna, Cigna, Coventry, UMR.

Located at Coleman Village shopping center in Roswell, Hazel Family Eyecare provides optometry services to people of all ages in a welcoming, state of the art environment. Our professional eye care staff will be happy to assist you with your vision needs. Whether you are interested in making an appointment for a medical eye consultation, need an annual eye exam, or just need glasses, we can help!

2013 @ Hazel Family EyeCare | 930 Marietta Hwy #400 Roswell, GA 30075 | Telephone: 770.998.3937 | Fax: 770.783.5066 | info@hazeleyecare.com