E.V. Niemczyk, O.D. & Associates - Fill out your forms before your visit

Click to fill out forms before your visit

Want to fill out forms early?

Printable version of our forms are linked below. Just click to print out the forms you need before your visit, and you can fill them out in the comfort of your home.

Consent Form
(VSP patients only)

Patient Information
(all new patients should
read, and are required
to complete, this form)

HIPPA Privacy Notice
(all our patients should
read, and are mandated
to sign, this form)

Contact Lens Policy
(all patients considering
contact lenses should
read this form)

Not sure which forms you need? Please feel free to contact us and we'll be happy to answer any questions you have.

These forms require Adobe Acrobat Reader to view and print them. Most systems have this software already installed, but if yours does not you can download it free from the Adobe Acrobat Reader download page.