Drs. George, Strickler & Lazer: The Eye MDs
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Patient Registration Forms

Your initial appointment usually involves a complete eye exam including dilation of the pupil. This can take 1 to 2 hours. There is paperwork required at the time of registration. This paperwork takes several minutes for new patients. An abbreviated version is also required for follow up visits if it has been more than 1 year since your last exam.

To save time, you can print the forms below and fill them out prior to coming to the office. Please carry them with you when you come in rather than mailing or emailing them to us.

New Patients

New patients should fill out a Patient Registration form and a New Patient Medical History form.

 

Established Patients

Established patients who have not filled out a medical history form within the last six months should fill out an Interim Visit Medical History form.

A Patient Registration form should only be filled out if there has been a change of address, insurance, or other personal information.

 
 
 
   

Other Notes About Your Visit

Payment is due at the time of service (self pay, co-pays, refractions, deductibles, etc.) so please bring a form of payment.

Medicare assignment is accepted. 

You may want to bring a driver as pupil dilation can make driving difficult for some patients.

Notice of Privacy Practices
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