Phone: 937-393-3212




Please review our privacy practices before your examination. If you have any questions feel free to ask.

Please fill out your medical and eye history and bring with you to your examination.

Please fill out the registration form with your insurance information and bring with you to the examination.

Below are patient history forms. Please fill out the registration and history forms and bring with you to your exam along with your current glasses and sunglasses. If you are a new patient who wears contact lenses please bring a box or blister pack from your current contact lenses so we know exactly which type of lens you are wearing. If you are coming in for an InfantSEE® exam there is a history form below specific to InfantSEE®.

InfantSEE® history form