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Online Forms

At Within Sight Vision Center, we value your time. In an effort to save you time in our office, you can download and complete our patient form(s) prior to your appointment.

  • You will need AdobeReaderĀ® to download and complete the forms. Click here to download.
  • Download the required form(s). Print out the form(s) and complete the required information.
  • Fax your printed and completed form(s) to our office or bring them with you to your appointment.

Consent to Treat Minors

If you're child is coming in for an appointment without you, the parent/legal guardian, please fill this out and sign it. This allows your child to be treated without yourself being present. Without this form, your child may not receive treatment the day they are scheduled for.

Download File


Established Patient Forms

Help us get to know a little bit about you and your health history. Also provide any insurance information that may be applied to your exam and services.

Download File


New Patient Forms

Authorize us to file your insurance as well as review the patient responsibility.
New patients only need to fill out this form.

Download File


Infant Exam

Use this form to supply us with a health history of your child to provide the best service possible. (For patients younger than 1 year old)

Download File


Infant Development

Here you will find an informative guideline of your newborn's ocular health and what you should expect from ages one to twelve months.
This is not needed for the exam; it is just information about infant vision

Download File


Release Authorization

Print and fill out this form is you are either wanting us to obtain records from another office for you or wanting us to send your records to another provider.

Download File


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Exclusive Offer

Receive $100 Off on second complete pair of glasses.

Location

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Hours of Operation

Our Regular Schedule

Monday:

8:00 am-5:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-5:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

8:00 am-12:00 pm

Saturday:

Closed

Sunday:

Closed