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.

none 7:30 AM - 5:30 PM 7:30 AM - 5:30 PM 7:30 AM - 5:30 PM 7:30 AM - 5:30 PM 7:30 AM - 5:30 PM Closed Closed https://www.google.com/search?q=Roosevelt+Vision&source=hp&ei=kUkYYs_jH6Tl2roPzca3iA8&iflsig=AHkkrS4AAAAAYhhXoX_SshIkFj636aaJDOwIsGLO90Ii&ved=0ahUKEwiP8MLE8Zn2AhWkslYBHU3jDfEQ4dUDCAg&uact=5&oq=Roosevelt+Vision&gs_lcp=Cgdnd3Mtd2l6EAMyBQgAEIAEMgUIABCABDIFCAAQgAQyBQgAEIAEMgUIABCABDIFCAAQgAQyCAgAEIAEEMkDMgUIABCABDIFCAAQgAQyBQgAEIAEOggIABCPARDqAjoICC4QjwEQ6gJQeFh4YLUGaAFwAHgAgAFFiAFFkgEBMZgBAKABAqABAbABCg&sclient=gws-wiz#lrd=0x54901472162ec599:0xc86cb6cb9551860d,3,,, https://www.yelp.com/writeareview/biz/eSg7XmBVeX2Uckn0h6KHTA?return_url=%2Fbiz%2FeSg7XmBVeX2Uckn0h6KHTA&review_origin=biz_details_war_button https://www.facebook.com/RooseveltVision/reviews/?ref=page_internal 7:30 AM - 5:30 PM https://www.revolutionphr.com/portal/welcome.htm https://personapay.com/rooseveltvision (855) 266-7243 May 16, 2022