Patient Registration Form

Patient Registration FormThe Eye Center2019-07-22T18:41:36-04:00

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.

20% OFF iLASIK (Plus get an additional $800 off when you schedule within 30 days!)

In 2020, thousands took control of what they could to improve their life and chose to see better and live better with LASIK from The Eye Center!

No matter what the New Year brings, let’s face it with clear vision! In fact, let’s face it with BETTER vision with iLASIK. iLASIK is affordable with huge savings, all-inclusive pricing, and payments as low as $167 per month! For a limited time, you can save 20% off iLASIK plus save an additional $800 when you schedule within 30 days!

Register to get your 20% savings on iLASIK

Better Vision Through Better Care

Patient Registration Form

Patient Registration Form

FACE THE YEAR WITH BETTER VISION!