Patient Forms
For your convenience, we have two options to provide your information & medical history to Lifetime Eyecare before your appointment:
- You can click the handy link to our online patient communication system NEXUS and fill out a secure online form. You will be asked to complete the HIPAA form and the Contact Lens Consent (if you wear contacts) when you arrive at our office (or you can print from below and bring with you).
Hint: take note of the “Submit Guest Form” button at the top of the form. It’s greyed out when you begin the form–once you fill in all required answers, go back to the top and that button should be green and you can submit by clicking the green box. Don’t look for a button at the end!
- If you prefer to fill out paper forms, you can use the “Downloadable Forms” links below to print out paper forms. Otherwise, please ask to have paper forms mailed to you in advance (if we have at least a week until your appointment). Fill out the forms and bring them to your appointment.
Downloadable Forms
- Patient Registration Form [PDF]
- Patient Health History [PDF]
- Contact Lens Patient Consent Form [PDF]
- HIPAA Receipt of Notice of Privacy Practices [PDF]