Patient Forms
Eye Care Service Forms
For your convenience, we have made our patient forms available online so that you can fill them out in advance. When you come for your appointment, please bring the completed forms with you and give them to the receptionist as you check in. This will allow us to serve you more promptly. If you prefer, you may arrive for your appointment fifteen minutes early to complete the necessary paperwork.
PATIENT FORMS
To print the patient forms, please click on the link below that best describes the type of exam for which you are scheduled:
For your visit to the Optometrist:
REGISTRATION FORM
REGISTRATION FORM (SPANISH)
MEDICAL HISTORY FORM
MEDICAL HISTORY FORM (SPANISH)
PRIVACY NOTICE FORM (READ ONLY)
RELEASE OF INFORMATION (OPTIONAL)
For your visit to the Ophthalmologist:
REGISTRATION FORM – CEP
MEDICAL HISTORY FORM – CEP
MEDICAL HISTORY FORM – CEP (SPANISH)
PRIVACY NOTICE FORM (READ ONLY)
FINANCIAL POLICY – CEP
RELEASE OF INFORMATION (OPTIONAL)
Thank you for choosing Rosin Eyecare as your eye care provider!
Professional and clinically on target. My wife finally has received excellent care after being examined at Rosin. Highly recommend. Thank you.
Dan W.
I loved my visit here. I had a great doctor and I highly recommend her. She made the visit easy and smooth but was very detailed in her work. She was very open to my suggestions and gave me lots of options as far as lenses and gave me advice on how to improve my eyesight. The best visit with an Optometrist that I have ever had!
Glenn H.
