Forms

Forms

Forms

Forms

Forms

Forms

The patient registration package includes our intake form, medical history questionnaire, and contact lens services explanation. Please complete these forms in advance of your visit.

Please also bring a list of your current medications, contact information for your primary care provider, and preferred pharmacy.

Contact lens wearers, new to Roosevelt Vision, please bring along your current contact lens prescription or current boxes so we can enter this information into your file.

If you complete this package of forms in advance of your visit, you will receive $20 off the purchase of a complete pair of glasses (expires 90 days from date of visit, not to be combined with other discounts or VSP insurance).

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