Patient Registration Form

Patient Registration FormThe Eye Center2019-07-22T18:41:36+00:00

Patient Registration Form

Prior to your office visit, please follow the instructions below to complete the Patient Registration Form.

INSTRUCTIONS:

Download and save the Patient Registration Form PDF file.
Open the Patient Registration Form PDF file.
Print the Form.
Fill out the Patient Form completely.
Please sign the Form and bring it with you to your office visit. Thank you.

* The Patient Registration Form is Adobe Acrobat PDF format. Adobe Acrobat Reader.

Announcing the year of 2020… 20/20 vision that is! 20/20 vision at The Eye Center to be exact! You see achieving your vision of 20/20 has turned into our goal and we want to make it easier and more affordable than ever! That’s why we are giving you 20% off your 20/20 with iLASIK with iDesign, PLUS a Free consultation, and no interest financing. A higher number of people seeing 20/20 or better thanks to one of Northern Virginia’s most experienced LASIK surgeons, Dr. Boutros, and often with better night vision and sharpness than with glasses and contacts. Schedule your Free LASIK consultation online.

Better Vision Through Better Care

Patient Registration Form

Patient Registration Form

The Year of Better Vision is Here! 20% off iLASIK