Please fill out the Patient Registration Form prior to your office visit. The Form has been designed to make it easy to download and print. Please fill out and sign the Form and bring it with you to your office visit.
Patient Registration Form (PDF/243k) *
- Download and save the PDF form to your computer:
There are 2 ways to save a PDF file from a web browser:
A) Click on the Patient Registration Form (PDF/243k) * link and open the form directly in your browser, you can then SAVE it to your computer, or
B) Right-mouse click on the link and select 'SAVE TARGET AS' to save it to your computer.
- Once you saved the PDF file on your computer, find the PDF file and open it.
- Print the Form.
- Fill out the Patient Form completely.
- Please sign the Form and bring it with you to your office visit. Thank you.
Contact us and find out why The Eye Center is one of the best choices for LASIK in VA. Call one of our offices in Northern Virginia: Leesburg, Fairfax, Sterling, Alexandria, Manassas. If you or someone you know is interested in finding out more about the Advanced CustomVue procedure, please call us at 888-844-2020.