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Online Patient Registration Form

lock icon Please complete the information below and submit the form online, or if you prefer print out the form after full or partial completion, and bring it when you come to our office. This form contains confidential information and is delivered to your doctor through a secure Internet connection.

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We sure have missed our patients!

We have implemented new sanitation protocols to keep our patients safe. Keeping our community healthy has always been our number one priority. Please be patient as we are seeing fewer patients daily and by appointment only to minimize everyone’s risk. Our team is taking precautions to ensure your visit is safe and that we can take care of you in a timely manner. Please call the office for hours and available times for exams, check-ups, eyewear pick up and adjustments. Please call the office for hours and availability. (301) 563-9528