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Optometric and Ophthalmologic Informational Forms

If you are a new patient please print out all new patient forms, fill them out and bring them with you when you come for your first office visit.

If you are having surgery please print out all the forms for the surgery you are having. Some of the forms are instructions and some are information the office needs from you.

Printing and filling out these forms will help reduce the time you spend filling out paper work during your visit.

New Patient Forms
  • New Patient Registration (PDF / HTML)
  • Insurance explanation (PDF / HTML)
  • Patient Insurance Information (PDF / HTML)
Cataract Surgery Forms
  • Cataract and Refractive Lens Exchange Questionnaire (PDF / HTML)
  • Preoperative Instructions for Cataract Surgery (PDF / HTML)
  • Post-Op Instructions Cataract (PDF / HTML)
LASIK/PRK Surgery Forms
  • LASIK Questionnaire (PDF / HTML)
  • LASIK Pre-Op Instructions (PDF / HTML)
  • PRK Post-Op Instructions (PDF / HTML)
  • Dry Eye Assessment (PDF / HTML)


North Location:
7075 Campus Drive Suite 100
Colorado Springs, Colorado 80920
Office: (719) 265-5663
Fax: (719) 265-5685
     Downtown Location:
525 N. Tejon Street
Colorado Springs, Colorado 80903
Office: (719) 471-2020
Fax: (719) 633-7379
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