Patient 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 feel free to print and fill out the necessary forms as outlined below and bring them to your appointment. If you prefer, you may arrive for your appointment a few minutes early and fill out the forms in our office.

New Patients or patients who have not had an appointment in 3 years:

Existing Patients:

EXISTING PATIENT INFORMATION FORM

Accurate, up-to-date patient information allows 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. The HIPPA privacy policy form is for your records only.

Patient Forms

New Patients or patients who have not had an appointment in 3 years:

Existing Patients:

Accepted Insurances

Vision Insurances: VSP, Eyemed, Superior Vision, Avesis, Spectera, NVA, Tricare, Avesis, Ambetter, Medicaid (Exam only)

Medical Insurances: BCBS, United Health Care, Medicare, Aetna, Cigna, Coventry, UMR, Humana, Avesis, Medicaid, Ambetter, Tricare

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