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HELPING YOU FEEL PREPARED

Alma Optics Patient Forms

Completing your patient forms ahead of time can help make your visit quicker and more comfortable. We’ve made it easy to prepare before your appointment so you can spend less time at check-in and more time focused on your care.

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FAST, SECURE, & PAPERLESS

Online Registration Hub

To provide the highest standard of eye care, we ask all new and returning patients to update their information each year. This helps us keep your records accurate and ensures your care is thorough.

Before completing your forms, please have the following ready: your vision and/or medical insurance cards, a list of current medications, and any relevant medical history or recent changes.

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Please Present all Insurance Cards
Patient Name *
Today's Date *
Date of Birth *
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Sex *
Address *
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Emergency Contact Information and Authorization for Disclosure of Medical Information

I authorize The Optics Group to disclose my protected health information (PHI) and/or contact the following individual(s) in the event of an emergency or for purposes regarding my clinical care, billing, or appointment coordination:

Contact 1 Emergency Contact?
Contact 1 Authorized to make Medical Decisions?
Contact 2 Emergency Contact?
Contact 2 Authorized to make Medical Decisions?

The following section is required if you are not the primary insurance policyholder. Please complete all fields below.

Policy holder's Date of Birth
Policy holder's Address
Policy holder's Date of Birth
Policy holder's Address

Our Standard of Care policy is located at the bottom of this page.

By signing below, I acknowledge that I have read and understood the Standard of Care policy and the information above, and that I have had the opportunity to ask questions. 

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Date *

Standard Of Care

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WE’RE HERE TO HELP

Complete Your Forms Before You Arrive

Take a few minutes to fill out your patient forms ahead of your visit—it’s a simple way to make your check-in smoother. If you need assistance or have questions while completing your forms, our eye clinic is always here to help.