Patient Information and Forms

How to prepare for your visit

Insurance Cards

If you have medical or vision insurance, be sure to bring in your up-to-date insurance card(s). We will copy this information into your health record. This applies to both new and established patients.

If you do not have insurance or wish to pay with cash, please call our clinic for pricing.

Intake Forms

Like most healthcare professions we require a certain amount of information about you prior to your visit. This information includes, but is not limited to:

We collect this information from you directly when you fill out your intake form. This form is required for both new and established patients. There are three ways you can fill out this form:

  1. Fill it out at the clinic: We ask that you arrive 15 minutes early to your appointment to allow for time to fill out your intake form.
  2. Do it Online: Go paperless and fill out your intake form online.
  3. Print it out at home: You can also print the intake form and fill it out at your home, bringing it with you when it is time for your appointment. If you do this, then you are not required to arrive 15 minutes early. This can be extra beneficial if you have multiple family members coming in for appointments. You can find a link to the intake form using the button below.

If you have questions about the intake form, please call our office.

Print your Intake Form

Online Intake Form

How often do I need to fill out an intake form?

Once every year. Regardless if your appointment is for an annual eye exam, dry eye treatment, or any other service we offer.

I have already filled out this form before, why do I need to do it again?

There are two main reasons we require the intake form to be filled out every year:

  1. Your Insurance: Insurance companies require that we obtain the most up-to-date information about you, and that some of the information you provide matches their records.
  2. It helps us provide better care: Filling out this form accurately will allow us to see what has changed since your last visit. As an example, say you were diagnosed with Type II Diabetes since your last eye exam. It is possible that your optometrist may be unaware of this, as well as any new medications you are taking for it. The intake form asks specifically about this disease and your medications, and it may be the prompt you need to give your optometrist that information.

The intake form will also be scanned into your Electronic Health Record (EHR) at Valley Eye Clinic, so that we can refer back to it in the future, if needed.

Information for New Patients

Previous Records

If you were previously the patient of another eye clinic, it can be beneficial to have your old optical records sent over to Valley Eye Clinic. This is especially important if you have any disease that greatly affects the eyes, such as glaucoma, macular degeneration, or Type II Diabetes. We make this process simple. When you come into our clinic for your appointment, we will have you sign a consent and release form which we will then send to your old clinic. They will send us your old records and we will keep them on file at Valley Eye Clinic as part of your new Electronic Health Record.

This process is not required to be a patient at Valley Eye Clinic, but is an extra step that one can take should they want their optical health history more organized at their new clinic.

Intake Forms

As stated above in the Intake Form section, be sure to arrive 15 minutes prior to your appointment to allow for ample time to fill out your intake form. You can also print out the form and fill it out at home, bringing it with you at your scheduled appointment time.