Once you have completed your forms, please visit our online frame gallery so that you can pick out your next pair of glasses before your visit!

If you would prefer to print out paper forms, please click here to download the PDF.

Be sure to bring the completed forms with you when you come in for your visit.

If you are an existing patient and would like to update your insurance on file, please complete the following:

​If you are a contact lens wearer or LASIK patient, please also complete the following:

Patient Forms

New patients and any returning patient who hasn't been seen in at least 3 years: 

Please complete the forms below prior to their visit. Children under 18 must have a parent or guardian sign each form.

Please fill out and hit Submit at the end of each form; do not print. If you prefer to print your forms, there is a link at the bottom of this page to download a PDF of the paperwork.

Phone: 203.265.5152
Fax: 203.265.1562
821 North Main St. Ext
Wallingford, CT 06492